Provider Demographics
NPI:1669008355
Name:MEDINA, TAYLOR CHRISTINE (FNP-C, FNP-BC)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:CHRISTINE
Last Name:MEDINA
Suffix:
Gender:F
Credentials:FNP-C, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 S YALE AVE STE 1400
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3331
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 W 151ST ST S STE 202
Practice Address - Street 2:
Practice Address - City:GLENPOOL
Practice Address - State:OK
Practice Address - Zip Code:74033-4530
Practice Address - Country:US
Practice Address - Phone:918-321-7400
Practice Address - Fax:918-321-7415
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-13
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK208942363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily