Provider Demographics
NPI:1508431271
Name:REYES MEDINA, ANISLEY (APRN)
Entity type:Individual
Prefix:
First Name:ANISLEY
Middle Name:
Last Name:REYES MEDINA
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11321 SW 239TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-3121
Mailing Address - Country:US
Mailing Address - Phone:786-720-3100
Mailing Address - Fax:
Practice Address - Street 1:4995 NW 72ND AVE STE 102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33166-5643
Practice Address - Country:US
Practice Address - Phone:786-360-3584
Practice Address - Fax:786-360-3867
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11012359363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty