Individual
IVAN REGALADO RODRIGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4614 WISTERIA LN, FORTSON, GA 31808-6986
(770) 882-1728
Mailing address
4614 WISTERIA LN, FORTSON, GA 31808-6986
(770) 882-1728
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
APRN11025390
FL
363LF0000X
Family Nurse Practitioner
Primary
RN291972
GA
Other
Enumeration date
03/21/2023
Last updated
10/12/2025
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