Provider Demographics
NPI:1750889986
Name:EDRINGTON-MEDINA, ELISHA JEAN (FNP)
Entity type:Individual
Prefix:MRS
First Name:ELISHA
Middle Name:JEAN
Last Name:EDRINGTON-MEDINA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:ELISHA
Other - Middle Name:JEAN
Other - Last Name:EDRINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7703 FLOYD CURL DR # MC7977
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-450-9890
Mailing Address - Fax:
Practice Address - Street 1:2833 BABCOCK RD STE 302
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-450-9890
Practice Address - Fax:210-450-4985
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136055363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX382140701Medicaid
TX382140702OtherCSHCN