Provider Demographics
NPI:1780206789
Name:MEDINA, TERESSA M (RN)
Entity Type:Individual
Prefix:
First Name:TERESSA
Middle Name:M
Last Name:MEDINA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8319 BROKEN WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-6812
Mailing Address - Country:US
Mailing Address - Phone:609-217-3122
Mailing Address - Fax:727-815-1174
Practice Address - Street 1:8319 BROKEN WILLOW LN
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-6812
Practice Address - Country:US
Practice Address - Phone:609-217-3122
Practice Address - Fax:727-815-1174
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL9429868163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health