Provider Demographics
NPI:1144009408
Name:MILLIEN-POLK, REGINE (RN)
Entity type:Individual
Prefix:
First Name:REGINE
Middle Name:
Last Name:MILLIEN-POLK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 GOLDEN POPPY CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-6441
Mailing Address - Country:US
Mailing Address - Phone:407-844-7437
Mailing Address - Fax:
Practice Address - Street 1:1611 GOLDEN POPPY CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824-6441
Practice Address - Country:US
Practice Address - Phone:407-844-7437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9454817163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy