Provider Demographics
NPI:1396706842
Name:GERMONPREZ, REGINA GAYLE (APRN)
Entity type:Individual
Prefix:MS
First Name:REGINA
Middle Name:GAYLE
Last Name:GERMONPREZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:REGINA
Other - Middle Name:GAYLE
Other - Last Name:FRUITS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFNP
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-424-1600
Mailing Address - Fax:239-424-1640
Practice Address - Street 1:1682 NE PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-1756
Practice Address - Country:US
Practice Address - Phone:239-424-1600
Practice Address - Fax:239-424-1640
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11007037363LF0000X, 363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109026300Medicaid
IN200175760Medicaid
IN220620RRRMedicare ID - Type Unspecified