Provider Demographics
NPI:1073195541
Name:MEDINA, MERARI
Entity Type:Individual
Prefix:
First Name:MERARI
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12740 PALAPA LOOP
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34610-6827
Mailing Address - Country:US
Mailing Address - Phone:787-637-0819
Mailing Address - Fax:
Practice Address - Street 1:12740 PALAPA LOOP
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34610-6827
Practice Address - Country:US
Practice Address - Phone:787-637-0819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-24
Last Update Date:2021-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator