Provider Demographics
NPI:1922470731
Name:MEDINA, ALICIA M (NP-C)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:M
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 1:3540 STATE ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-1352
Mailing Address - Country:US
Mailing Address - Phone:330-688-9918
Mailing Address - Fax:
Practice Address - Street 1:3540 STATE ROUTE 59
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-1352
Practice Address - Country:US
Practice Address - Phone:330-688-9918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.18297-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily