Provider Demographics
NPI:1881127355
Name:MEDINA, OLGA MARIA (APRN)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:MARIA
Last Name:MEDINA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:OLGA
Other - Middle Name:MARIA
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1600 LAKELAND HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3019
Mailing Address - Country:US
Mailing Address - Phone:863-680-7000
Mailing Address - Fax:866-264-8519
Practice Address - Street 1:2300 E COUNTY ROAD 540A
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-3825
Practice Address - Country:US
Practice Address - Phone:863-680-7486
Practice Address - Fax:866-264-8519
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9214464363LA2200X
FLAPRN9214464363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health