Provider Demographics
NPI:1245992536
Name:REGAN, COLLEEN (RN, MSN, CPNP)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:REGAN
Suffix:
Gender:F
Credentials:RN, MSN, CPNP
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 2089
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78627-2089
Mailing Address - Country:US
Mailing Address - Phone:512-930-4776
Mailing Address - Fax:
Practice Address - Street 1:4112 LINKS LN STE 102
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-3902
Practice Address - Country:US
Practice Address - Phone:512-436-9455
Practice Address - Fax:855-299-7012
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1056664363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics