Provider Demographics
NPI:1902179948
Name:PADGETT, REGINA
Entity Type:Individual
Prefix:MISS
First Name:REGINA
Middle Name:
Last Name:PADGETT
Suffix:
Gender:F
Credentials:
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 608503
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32860-8503
Mailing Address - Country:US
Mailing Address - Phone:407-547-2711
Mailing Address - Fax:407-289-8801
Practice Address - Street 1:6249 EDGEWATER DR.
Practice Address - Street 2:V1, STE. 7
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-4739
Practice Address - Country:US
Practice Address - Phone:407-547-2711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-22
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL202501041C0700X
171M00000X
FL251B00000X
FLSW202501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL680903198Medicaid
FL680903196Medicaid
FL680903168Medicaid