Provider Demographics
NPI:1952765869
Name:ORTIZ, JOHANA MEDINA (CNP)
Entity Type:Individual
Prefix:
First Name:JOHANA
Middle Name:MEDINA
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:JOHANA
Other - Middle Name:PAOLA
Other - Last Name:MEDINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:1000 MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-7694
Mailing Address - Country:US
Mailing Address - Phone:678-312-3294
Mailing Address - Fax:678-312-3282
Practice Address - Street 1:1000 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7694
Practice Address - Country:US
Practice Address - Phone:678-312-3294
Practice Address - Fax:678-312-3282
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN181307363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner