Basic Information
| Provider Information | |||||||||
| NPI: | 1093001745 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRAVIS | ||||||||
| FirstName: | REGINA | ||||||||
| MiddleName: | IRENE | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 943 S BENEVA RD | ||||||||
| Address2: | SUITE 306 | ||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342322476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9413628644 | ||||||||
| FaxNumber: | 9419544440 | ||||||||
| Practice Location | |||||||||
| Address1: | 4642 BALBOA PARK LOOP | ||||||||
| Address2: | |||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342114960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9732294223 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2011 | ||||||||
| LastUpdateDate: | 04/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | OS13374 | FL | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | OS13374 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.