Healthcare Provider Details

I. General information

NPI: 1982950440
Provider Name (Legal Business Name): OLGA LUNA MEDINA MS, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 PONCE DE LEON BLVD FL 3
CORAL GABLES FL
33146-2513
US

IV. Provider business mailing address

5555 PONCE DE LEON BLVD FL 3
CORAL GABLES FL
33146-2513
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-8644
  • Fax:
Mailing address:
  • Phone: 305-243-8644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9314112
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN9314112
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: