Provider Demographics
NPI:1972186138
Name:MEDINA PEREZ, KANDY LIZZETH (FNP-C)
Entity Type:Individual
Prefix:
First Name:KANDY
Middle Name:LIZZETH
Last Name:MEDINA PEREZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KANDY
Other - Middle Name:LIZZETH
Other - Last Name:MEDINA PEREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7908 N COTTON LN
Mailing Address - Street 2:
Mailing Address - City:WADDELL
Mailing Address - State:AZ
Mailing Address - Zip Code:85355-9751
Mailing Address - Country:US
Mailing Address - Phone:623-512-8308
Mailing Address - Fax:
Practice Address - Street 1:7908 N COTTON LN
Practice Address - Street 2:
Practice Address - City:WADDELL
Practice Address - State:AZ
Practice Address - Zip Code:85355-9751
Practice Address - Country:US
Practice Address - Phone:623-512-8308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN211082163W00000X
AZRNP267355363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse