Provider Demographics
NPI:1356092183
Name:MEDINA, EMERALD (FNP)
Entity Type:Individual
Prefix:
First Name:EMERALD
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 PASSAIC ST
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-5813
Mailing Address - Country:US
Mailing Address - Phone:973-249-8100
Mailing Address - Fax:973-249-8110
Practice Address - Street 1:298 PASSAIC ST
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-5813
Practice Address - Country:US
Practice Address - Phone:973-249-8100
Practice Address - Fax:973-249-8110
Is Sole Proprietor?:No
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01254300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily