Provider Demographics
NPI:1568937852
Name:MEDINA, NATALIE MARIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:MARIE
Last Name:MEDINA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 SW 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-2968
Mailing Address - Country:US
Mailing Address - Phone:305-266-2424
Mailing Address - Fax:305-692-0728
Practice Address - Street 1:2575 SW 67TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2968
Practice Address - Country:US
Practice Address - Phone:305-266-2424
Practice Address - Fax:305-692-0728
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9304721207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1679959498OtherNPI
FL47-3682779OtherTAX ID