Healthcare Provider Details

I. General information

NPI: 1871020073
Provider Name (Legal Business Name): LEAH NICOLE MEDINA APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2017
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7369 SHERIDAN ST STE 203
HOLLYWOOD FL
33024-2776
US

IV. Provider business mailing address

7369 SHERIDAN ST STE 203
HOLLYWOOD FL
33024-2776
US

V. Phone/Fax

Practice location:
  • Phone: 954-369-4111
  • Fax: 954-350-0909
Mailing address:
  • Phone: 954-369-4111
  • Fax: 954-350-0909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9450474
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN9450474
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: