Provider Demographics
NPI:1326594219
Name:MEDINA, BRIANNE (RN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:BRIANNE
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:MS
Other - First Name:BRIANNE
Other - Middle Name:ALEXIS AKEMI
Other - Last Name:SHOJI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, FNP
Mailing Address - Street 1:20 VISTA REAL DR
Mailing Address - Street 2:ROLLING HILLS ESTATES
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-4227
Mailing Address - Country:US
Mailing Address - Phone:310-539-2280
Mailing Address - Fax:310-539-1188
Practice Address - Street 1:1505 WILSON TER STE 250
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4075
Practice Address - Country:US
Practice Address - Phone:818-246-7115
Practice Address - Fax:877-366-1148
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA760321163W00000X
CA95004897363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse