Provider Demographics
NPI:1255494092
Name:MEDINA, TYRONE J (MD)
Entity type:Individual
Prefix:
First Name:TYRONE
Middle Name:J
Last Name:MEDINA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 GOODLETTE ROAD N
Mailing Address - Street 2:SUITE 130
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5402
Mailing Address - Country:US
Mailing Address - Phone:239-649-3333
Mailing Address - Fax:239-649-3386
Practice Address - Street 1:800 GOODLETTE ROAD N
Practice Address - Street 2:SUITE 130
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5402
Practice Address - Country:US
Practice Address - Phone:239-649-3333
Practice Address - Fax:239-649-3386
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59671207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00107425OtherRRMC
FL12203OtherBCBS
FL371615500Medicaid
F00756Medicare UPIN
FL371615500Medicaid