Provider Demographics
NPI:1164232179
Name:REGONDOLA, MARIA AGNES
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:AGNES
Last Name:REGONDOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AGNES
Other - Middle Name:
Other - Last Name:REGONDOLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:8025 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77713-8486
Mailing Address - Country:US
Mailing Address - Phone:409-658-9558
Mailing Address - Fax:
Practice Address - Street 1:4401 GARTH RD
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-2122
Practice Address - Country:US
Practice Address - Phone:281-420-8600
Practice Address - Fax:281-420-8414
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1179938363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care