Provider Demographics
NPI:1952630378
Name:LONGINOTTI, REGINA M (APRN)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:M
Last Name:LONGINOTTI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 EMBARCADERO CTR
Mailing Address - Street 2:LOBBY LEVEL
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-3823
Mailing Address - Country:US
Mailing Address - Phone:415-578-3100
Mailing Address - Fax:415-291-0489
Practice Address - Street 1:2 EMBARCADERO CTR
Practice Address - Street 2:LOBBY LEVEL
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-3823
Practice Address - Country:US
Practice Address - Phone:415-578-3100
Practice Address - Fax:415-291-0489
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2299864363L00000X
NC5006778363LA2200X, 363LX0001X
CA23323363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004236346Medicaid