Provider Demographics
NPI:1871941286
Name:GERVAIS, REGINE
Entity type:Individual
Prefix:
First Name:REGINE
Middle Name:
Last Name:GERVAIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REGINE
Other - Middle Name:
Other - Last Name:FILEMON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:7671 COUNTRY RUN PKWY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-8266
Mailing Address - Country:US
Mailing Address - Phone:407-731-3181
Mailing Address - Fax:
Practice Address - Street 1:541 E HORATIO AVE STE 100
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7316
Practice Address - Country:US
Practice Address - Phone:407-622-0793
Practice Address - Fax:866-362-3655
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9233654207RC0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty