Provider Demographics
NPI:1609843358
Name:REGIS, THERESA AUGUSTA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:AUGUSTA
Last Name:REGIS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:1155 35TH LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6521
Mailing Address - Country:US
Mailing Address - Phone:772-569-2330
Mailing Address - Fax:772-569-2630
Practice Address - Street 1:1155 35TH LN
Practice Address - Street 2:SUITE 100
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6521
Practice Address - Country:US
Practice Address - Phone:772-569-2330
Practice Address - Fax:772-569-2630
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2009-12-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9104895363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical