Provider Demographics
NPI:1205562444
Name:MEDRANO, IVAN MAXIMIALLIANO JR (FNP-BC)
Entity type:Individual
Prefix:MR
First Name:IVAN
Middle Name:MAXIMIALLIANO
Last Name:MEDRANO
Suffix:JR
Gender:M
Credentials:FNP-BC
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Mailing Address - Street 1:1400 NW 12TH AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1003
Mailing Address - Country:US
Mailing Address - Phone:305-689-7600
Mailing Address - Fax:305-243-1353
Practice Address - Street 1:1400 NW 12TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1003
Practice Address - Country:US
Practice Address - Phone:305-689-7600
Practice Address - Fax:305-243-1353
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-29
Last Update Date:2023-10-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11021122363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner