Provider Demographics
NPI:1972798494
Name:DEIPARINE, REGINA D (NLMT)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:D
Last Name:DEIPARINE
Suffix:
Gender:F
Credentials:NLMT
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:D
Other - Last Name:DEIPARINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NLMT
Mailing Address - Street 1:102 PINE TREE DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-2634
Mailing Address - Country:US
Mailing Address - Phone:386-547-3910
Mailing Address - Fax:386-615-4951
Practice Address - Street 1:533 N NOVA RD
Practice Address - Street 2:SUITE 102
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-4447
Practice Address - Country:US
Practice Address - Phone:386-615-4990
Practice Address - Fax:386-615-4951
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL45105174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45105OtherFLORIDA LICENSE