Provider Demographics
NPI:1972958569
Name:MEDINA ROMAN, VANESSA IVELISSE (ARNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:IVELISSE
Last Name:MEDINA ROMAN
Suffix:
Gender:F
Credentials:ARNP, FNP-BC
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:IVELISSE
Other - Last Name:FRANCOEUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:8025 LEE VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32829-8374
Mailing Address - Country:US
Mailing Address - Phone:866-389-2727
Mailing Address - Fax:866-389-2727
Practice Address - Street 1:8025 LEE VISTA BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32829-8374
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:866-389-2727
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9284369363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily