Provider Demographics
NPI:1568120335
Name:MEDINA, CRISTINA (FNP-C)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 HALPINE RD APT 1421
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-7627
Mailing Address - Country:US
Mailing Address - Phone:301-646-8363
Mailing Address - Fax:
Practice Address - Street 1:10901 CONNECTICUT AVE STE 100
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-1645
Practice Address - Country:US
Practice Address - Phone:240-290-1041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR220633363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily