Provider Demographics
NPI:1336611995
Name:JOLY, REGINE (RN, MPH, CHES, CCM,)
Entity Type:Individual
Prefix:
First Name:REGINE
Middle Name:
Last Name:JOLY
Suffix:
Gender:F
Credentials:RN, MPH, CHES, CCM,
Other - Prefix:MISS
Other - First Name:REGINE
Other - Middle Name:
Other - Last Name:JEAN-PIERRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:17521 SW 93RD PL
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-5768
Mailing Address - Country:US
Mailing Address - Phone:305-256-5480
Mailing Address - Fax:
Practice Address - Street 1:8895 SW 136TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-5816
Practice Address - Country:US
Practice Address - Phone:305-256-5480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2005292163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01OtherMEDICARE