Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Regina Marie Formentin, NP-C

Individual provider Nurse Practitioner · NPI 1700470275

Regina Marie Formentin, NP-C is a Nurse Practitioner in Mesa, Arizona. Qualified in 2020, 6 years ago. Practices with Summit Medical Group Arizona LLC, a 153-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Arizona.

Years since qualifying
6
Licensed in
AZ
In the registry since
2021
What do these letters mean?
NP-C — Nurse Practitioner, Certified
A nurse practitioner certified by the AANP.

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Practice location Address checks out

6242 E Arbor Ave Ste 111
Mesa, AZ 85206-1309
Phone: (602) 755-0800
Fax: (602) 560-2721
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 254655 (AZ)

Record details

NPI number1700470275
Entity typeIndividual (Type 1)
GenderFemale
Credentials NP-C
Sole proprietorYes
NPI enumeratedFebruary 25, 2021
Last updated in NPPESAugust 27, 2024
Certification dateAugust 27, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Summit Medical Group Arizona Llc — 153 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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