Provider Demographics
NPI:1821763103
Name:MEDINA, NIURKA
Entity Type:Individual
Prefix:
First Name:NIURKA
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10420 NW 74TH ST UNIT 101
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2457
Mailing Address - Country:US
Mailing Address - Phone:305-600-6457
Mailing Address - Fax:
Practice Address - Street 1:10420 NW 74TH ST UNIT 101
Practice Address - Street 2:
Practice Address - City:MEDLEY
Practice Address - State:FL
Practice Address - Zip Code:33178-2457
Practice Address - Country:US
Practice Address - Phone:305-600-6457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide