Provider Demographics
NPI:1740602192
Name:GISPERT MEDINA, ANALYER (CSFA)
Entity Type:Individual
Prefix:
First Name:ANALYER
Middle Name:
Last Name:GISPERT MEDINA
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 LUGANO CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-3434
Mailing Address - Country:US
Mailing Address - Phone:321-442-2454
Mailing Address - Fax:407-386-3006
Practice Address - Street 1:4220 LUGANO CT
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-3434
Practice Address - Country:US
Practice Address - Phone:321-442-2454
Practice Address - Fax:407-386-3006
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-18
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist