Provider Demographics
NPI:1801531793
Name:MEDINA, JESSICA ILEANA (WHNP-BC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ILEANA
Last Name:MEDINA
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ILEANA
Other - Last Name:BLANCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHNP-BC
Mailing Address - Street 1:10466 SW 27TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2765
Mailing Address - Country:US
Mailing Address - Phone:305-979-1580
Mailing Address - Fax:
Practice Address - Street 1:11760 SW 40TH ST STE 654
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-8103
Practice Address - Country:US
Practice Address - Phone:786-615-6123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11019448363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health