Provider Demographics
NPI:1730893496
Name:PIERRE, REGINE (PA)
Entity type:Individual
Prefix:
First Name:REGINE
Middle Name:
Last Name:PIERRE
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3041 BAVARIAN WEST DR APT 501
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46235-3451
Mailing Address - Country:US
Mailing Address - Phone:317-909-3880
Mailing Address - Fax:
Practice Address - Street 1:1899 N CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8259
Practice Address - Country:US
Practice Address - Phone:866-550-2212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1501-P.A363A00000X
AZ10226363A00000X
FLPACN46363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN9371-00-6668OtherSMARTHEALTH