Provider Demographics
NPI:1912388265
Name:BREWER, REGINA (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:
Last Name:BREWER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6411 E NORTHWEST HWY STE 120
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-8007
Mailing Address - Country:US
Mailing Address - Phone:469-495-9110
Mailing Address - Fax:
Practice Address - Street 1:6411 E NORTHWEST HWY STE 120
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-8007
Practice Address - Country:US
Practice Address - Phone:469-495-9110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-12
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128062363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily