Provider Demographics
NPI:1700535366
Name:TAYLOR, REGINA ELAINE (CNA)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:ELAINE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:ELAINE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1725 NE 8TH AVE APT D7
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32641-4772
Mailing Address - Country:US
Mailing Address - Phone:352-221-0004
Mailing Address - Fax:
Practice Address - Street 1:1725 NE 8TH AVE APT D7
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32641-4772
Practice Address - Country:US
Practice Address - Phone:352-221-0004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL409659251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health