Individual
MRS. REGINA D PETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, APRN, PMHNP
Contact information
Practice address
15462 SPOTTED STALLION TRL, JACKSONVILLE, FL 32234-2398
(352) 328-0571
Mailing address
15462 SPOTTED STALLION TRL, JACKSONVILLE, FL 32234-2398
(352) 328-0571
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN9339167
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN11018524
FL
Other
Enumeration date
04/17/2020
Last updated
06/03/2022
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