IVAN REGALADO RODRIGUEZ NPI 1639871866

NPI Information

  • NPI: 1639871866
  • Provider Name: IVAN REGALADO RODRIGUEZ
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 4614 WISTERIA LN
    FORTSON, GA
    ZIP 31808
  • Phone: (770) 882-1728

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NPI Details

Ivan Regalado Rodriguez is a family nurse practitioner in Fortson, GA. Ivan Regalado Rodriguez NPI is 1639871866. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

4614 WISTERIA LN
FORTSON, GA
ZIP 31808-986
Phone: (770) 882-1728

The NPI 1639871866 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Power Mobility Devices.

The enumeration date for this NPI number is 3/21/2023 and was last updated on 10/12/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LF0000XNurse PractitionerFamilyAPRN11025390FLORIDANo
2363LF0000XNurse PractitionerFamilyRN291972GEORGIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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