Provider Demographics
NPI:1235683822
Name:MEDINA, JEAN CLAUDE (DNP-AAPRN)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:CLAUDE
Last Name:MEDINA
Suffix:
Gender:M
Credentials:DNP-AAPRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2296 SW 166TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4445
Mailing Address - Country:US
Mailing Address - Phone:786-234-2519
Mailing Address - Fax:
Practice Address - Street 1:3156 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-3001
Practice Address - Country:US
Practice Address - Phone:754-217-3929
Practice Address - Fax:754-217-3931
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9348782363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner