Provider Demographics
NPI:1689109779
Name:PATILLO, REGINE (AGNP)
Entity Type:Individual
Prefix:MS
First Name:REGINE
Middle Name:
Last Name:PATILLO
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:MS
Other - First Name:REGINE
Other - Middle Name:
Other - Last Name:GUERRIER-PATILLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AGNP
Mailing Address - Street 1:18630 WHITE ASH LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-3427
Mailing Address - Country:US
Mailing Address - Phone:832-790-3070
Mailing Address - Fax:
Practice Address - Street 1:18630 WHITE ASH LN
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-3427
Practice Address - Country:US
Practice Address - Phone:832-790-3070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132820363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health