Provider Demographics
NPI:1700968484
Name:MATTHEWS, REGINA LOUISE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:LOUISE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:LOUISE
Other - Last Name:OYEKOYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17511 BRUCE B DOWNS BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3211
Mailing Address - Country:US
Mailing Address - Phone:813-915-5459
Mailing Address - Fax:813-515-7955
Practice Address - Street 1:17511 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3211
Practice Address - Country:US
Practice Address - Phone:813-915-5459
Practice Address - Fax:813-971-5468
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN2769802363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL300629800Medicaid
FL300629800Medicaid
FLE4434Medicare ID - Type Unspecified