Provider Demographics
NPI:1205379674
Name:MEDINA, JORGE ARTURO JR (FPMHNP-BC, MSN, RN)
Entity Type:Individual
Prefix:MR
First Name:JORGE
Middle Name:ARTURO
Last Name:MEDINA
Suffix:JR
Gender:M
Credentials:FPMHNP-BC, MSN, RN
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Mailing Address - Street 1:4849 N MESA ST STE 201
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5919
Mailing Address - Country:US
Mailing Address - Phone:915-351-6600
Mailing Address - Fax:915-351-6601
Practice Address - Street 1:6090 SURETY DR STE 304
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2056
Practice Address - Country:US
Practice Address - Phone:915-245-5150
Practice Address - Fax:888-337-3750
Is Sole Proprietor?:No
Enumeration Date:2016-12-02
Last Update Date:2021-07-16
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Provider Licenses
StateLicense IDTaxonomies
TXAP132755363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health