Provider Demographics
NPI:1619735701
Name:MEDINA, JOSE L SR (ARNP F03240384)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:L
Last Name:MEDINA
Suffix:SR
Gender:M
Credentials:ARNP F03240384
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15151 PIGEON PLUM LN
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5037
Mailing Address - Country:US
Mailing Address - Phone:407-729-0593
Mailing Address - Fax:
Practice Address - Street 1:15151 PIGEON PLUM LN
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-5037
Practice Address - Country:US
Practice Address - Phone:407-729-0593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF0320384363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily