Provider Demographics
NPI:1013444165
Name:MEDINA, ROBIN D (NP, FNP)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:D
Last Name:MEDINA
Suffix:
Gender:F
Credentials:NP, FNP
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:MUNOZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2625 E DIVISADERO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1431
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:785 N MEDICAL CENTER DR W
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6878
Practice Address - Country:US
Practice Address - Phone:559-387-1900
Practice Address - Fax:559-387-1950
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006754363L00000X
CANPF95006754363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner