Healthcare Provider Details

I. General information

NPI: 1285851147
Provider Name (Legal Business Name): PAULA MEDINA MEDINA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAULA MEDINA MEDINA MD

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W 6TH ST
JACKSONVILLE FL
32206-4324
US

IV. Provider business mailing address

345 S CONGRESS AVE
DELRAY BEACH FL
33445-4617
US

V. Phone/Fax

Practice location:
  • Phone: 904-253-1070
  • Fax: 904-253-1943
Mailing address:
  • Phone: 561-274-3100
  • Fax: 561-274-3103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number14,374
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN257
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: