Provider Demographics
NPI:1407319106
Name:MEDINA, RICHARD A (RNFA)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:A
Last Name:MEDINA
Suffix:
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3604 COVE MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-2378
Mailing Address - Country:US
Mailing Address - Phone:817-845-3419
Mailing Address - Fax:817-845-3419
Practice Address - Street 1:800 W RANDOL MILL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2504
Practice Address - Country:US
Practice Address - Phone:817-960-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX702529163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant