Provider Demographics
NPI:1417532821
Name:MEDINA SUAREZ, MANUEL (ARPN)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:
Last Name:MEDINA SUAREZ
Suffix:
Gender:M
Credentials:ARPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15280 NW 79TH CT STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5873
Mailing Address - Country:US
Mailing Address - Phone:305-558-3724
Mailing Address - Fax:786-907-4485
Practice Address - Street 1:9275 SW 152ND ST STE 212
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1774
Practice Address - Country:US
Practice Address - Phone:305-255-5995
Practice Address - Fax:305-255-3018
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11012137363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily