Provider Demographics
NPI:1437916392
Name:MEDINA ESTRADA, ROXANA OFELIA (NP)
Entity Type:Individual
Prefix:
First Name:ROXANA
Middle Name:OFELIA
Last Name:MEDINA ESTRADA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2994 N BEVERLY PL
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396-7796
Mailing Address - Country:US
Mailing Address - Phone:602-810-9514
Mailing Address - Fax:
Practice Address - Street 1:9515 W CAMELBACK RD STE 142
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-1364
Practice Address - Country:US
Practice Address - Phone:602-903-5365
Practice Address - Fax:888-846-8757
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ299343363LF0000X, 363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics