Provider Demographics
NPI:1477021053
Name:REGENT MEDICAL AND AESTHETIC CLINIC
Entity Type:Organization
Organization Name:REGENT MEDICAL AND AESTHETIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DULCIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:YELVERTON
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:850-843-1834
Mailing Address - Street 1:1209 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32347-2037
Mailing Address - Country:US
Mailing Address - Phone:850-843-1834
Mailing Address - Fax:
Practice Address - Street 1:1209 N CENTER ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32347-2037
Practice Address - Country:US
Practice Address - Phone:850-843-1834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-13
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care