Provider Demographics
NPI:1467851261
Name:MEDINA, NOEMI (MSS)
Entity Type:Individual
Prefix:
First Name:NOEMI
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:MSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 GRANDE CT APT 810
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-3127
Mailing Address - Country:US
Mailing Address - Phone:321-443-5612
Mailing Address - Fax:
Practice Address - Street 1:1707 ORLANDO CENTRAL PKWY STE 480
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-5785
Practice Address - Country:US
Practice Address - Phone:321-443-5612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-18
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker