Provider Demographics
NPI:1730481953
Name:DUBOIS-RODABAUGH, REGINA MARIE
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:MARIE
Last Name:DUBOIS-RODABAUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:MARIE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1025 SW 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0900
Mailing Address - Country:US
Mailing Address - Phone:352-732-6599
Mailing Address - Fax:
Practice Address - Street 1:5051 SE 110TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-3115
Practice Address - Country:US
Practice Address - Phone:352-732-6599
Practice Address - Fax:352-307-4417
Is Sole Proprietor?:No
Enumeration Date:2010-11-19
Last Update Date:2023-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN1897292363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009297800Medicaid
FL009297800Medicaid