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NPI Code Detail

MEDICARE: MEDINA TAN FNP-BC

MEDICARE: MEDINA TAN FNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner848581NV

General Provider Information

NPI Number : 1295534782
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEDINA TAN FNP-BC
Provider Business Mailing Address
First Line : 6655 W SAHARA AVE STE A218
Second Line :
City : LAS VEGAS
State : NV
Zip : 89146-0847
Country : US
Telephone Number : 725-205-2457
Fax Number :
Provider Business Practice Location Address
First Line : 3753 HOWARD HUGHES PKWY STE 200
Second Line :
City : LAS VEGAS
State : NV
Zip : 89169-0952
Country : US
Telephone Number : 502-320-0023
Fax Number : 949-281-5550
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2025
Last Update Date : 12/02/2025

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