Provider Demographics
NPI:1851763965
Name:MEDINA, MARIA ALEXANDRA (NP-C)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ALEXANDRA
Last Name:MEDINA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 CHIMNEY ROCK CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4235
Mailing Address - Country:US
Mailing Address - Phone:704-497-4302
Mailing Address - Fax:
Practice Address - Street 1:805 CHURCH STREET NORTH
Practice Address - Street 2:SUITE 308
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025
Practice Address - Country:US
Practice Address - Phone:704-262-1059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007973363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily