Provider Demographics
NPI:1639711773
Name:MEDINA, JESSICA NICOLE (RNFA)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:NICOLE
Last Name:MEDINA
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5710 OGEECHEE RD
Mailing Address - Street 2:STE 200 PMB 314
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405
Mailing Address - Country:US
Mailing Address - Phone:760-731-0313
Mailing Address - Fax:760-731-0414
Practice Address - Street 1:156 W TAHOE DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-9421
Practice Address - Country:US
Practice Address - Phone:760-731-0313
Practice Address - Fax:760-731-0414
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-10
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN246577163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty