Healthcare Provider Details

I. General information

NPI: 1639885882
Provider Name (Legal Business Name): YOLANDA ISABEL MEDINA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 DOUGLAS AVE
ALTAMONTE SPRINGS FL
32714-2085
US

IV. Provider business mailing address

425 W COLONIAL DR STE 303
ORLANDO FL
32804-6863
US

V. Phone/Fax

Practice location:
  • Phone: 407-332-0003
  • Fax: 833-450-5404
Mailing address:
  • Phone: 321-332-6947
  • Fax: 689-304-0303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1290
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPACN74
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: