Provider Demographics
NPI:1598812794
Name:ROCZNIAK, REGINA JO (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:JO
Last Name:ROCZNIAK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:REGINA
Other - Middle Name:JO
Other - Last Name:MANCINI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:1200 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1004
Mailing Address - Country:US
Mailing Address - Phone:336-832-7000
Mailing Address - Fax:
Practice Address - Street 1:2704 HENRY ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-3633
Practice Address - Country:US
Practice Address - Phone:336-621-3777
Practice Address - Fax:336-621-8374
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02313363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2762327OtherMEDICARE PTAN
G141335Medicare UPIN