Provider Demographics
NPI:1497389050
Name:REGINO, SARA AILEEN (MSN, APRN, AGPCNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:AILEEN
Last Name:REGINO
Suffix:
Gender:F
Credentials:MSN, APRN, AGPCNP-BC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:A
Other - Last Name:MAISONET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13207 PIKE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-4039
Mailing Address - Country:US
Mailing Address - Phone:727-259-8459
Mailing Address - Fax:
Practice Address - Street 1:13207 PIKE LAKE DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-4039
Practice Address - Country:US
Practice Address - Phone:727-259-8459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-23
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11006358207R00000X
FLNA363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health