Provider Demographics
NPI:1790572592
Name:MARCANO, REGINA (RN)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:MARCANO
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16632 LAKE SMITH RD
Mailing Address - Street 2:
Mailing Address - City:UMATILLA
Mailing Address - State:FL
Mailing Address - Zip Code:32784-8838
Mailing Address - Country:US
Mailing Address - Phone:407-205-5515
Mailing Address - Fax:
Practice Address - Street 1:16624 LAKE SMITH RD
Practice Address - Street 2:
Practice Address - City:UMATILLA
Practice Address - State:FL
Practice Address - Zip Code:32784-8838
Practice Address - Country:US
Practice Address - Phone:407-205-5515
Practice Address - Fax:352-669-0572
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13936310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL125712800Medicaid