MEDICARE: LUCIA MEDINA ANP

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
1	363LF0000X	Family Nurse Practitioner	1125709	TX
2	163W00000X	Registered Nurse	781728	TX

General Provider Information

NPI Number	:	1497382832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCIA MEDINA ANP

Provider Business Mailing Address
First Line	:	12668 TIERRA INCA DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79938-4815
Country	:	US
Telephone Number	:	915-703-9411
Fax Number	:

Provider Business Practice Location Address
First Line	:	1335 GERONIMO DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-1836
Country	:	US
Telephone Number	:	915-591-2704
Fax Number	:	915-598-3946

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2020
Last Update Date	:	07/17/2023

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Directions to “ LUCIA MEDINA ANP” Practice Location

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