Provider Demographics
NPI:1457132862
Name:MEDRANO, ANASTASIA (FNP-C)
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:
Last Name:MEDRANO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2236 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-4568
Mailing Address - Country:US
Mailing Address - Phone:432-258-2399
Mailing Address - Fax:
Practice Address - Street 1:3403 ANDREWS HWY # 300
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-5132
Practice Address - Country:US
Practice Address - Phone:432-522-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1138729363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily