Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | ARNP9327002 | FL |
N | 363LG0600X | Nurse Practitioner - Gerontology | F3405331 | NY |
NPI | 1083816946 |
---|---|
Provider Name | Ms. Regina Imari Washington |
First Address | Orange Park, FL 32065-3652 |
Second Address | Orange Park, FL 32065-3652 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2007 |
Last Update Date | 13/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q17217 | (02) | NY |