Provider Demographics
NPI:1467779272
Name:MINOR, REGINA NICOLE (FNP)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:NICOLE
Last Name:MINOR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:REGINA
Other - Middle Name:NICOLE
Other - Last Name:UNDERWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:35 GLEN RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-6081
Mailing Address - Country:US
Mailing Address - Phone:614-556-9592
Mailing Address - Fax:
Practice Address - Street 1:2 N ZACK HINTON PKWY
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-2317
Practice Address - Country:US
Practice Address - Phone:770-957-2984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH358981163W00000X
GARN212924363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse