Provider Demographics
NPI:1669689618
Name:SOWARDS-FOX, REGINA (BA)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:SOWARDS-FOX
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12158
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32120-2158
Mailing Address - Country:US
Mailing Address - Phone:386-868-1992
Mailing Address - Fax:386-868-1978
Practice Address - Street 1:1060 PELICAN BAY DR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32119-9700
Practice Address - Country:US
Practice Address - Phone:386-206-8061
Practice Address - Fax:386-868-1978
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL756724300Medicaid
FL102702700Medicaid