Healthcare Provider Details

I. General information

NPI: 1083549141
Provider Name (Legal Business Name): MARTHA MARIA MEDINA TERON NP CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7980 SW 24TH ST
MIAMI FL
33155-6550
US

IV. Provider business mailing address

8943 SW 25TH ST
MIAMI FL
33165-2020
US

V. Phone/Fax

Practice location:
  • Phone: 502-309-1985
  • Fax:
Mailing address:
  • Phone: 502-309-1985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARTHA MARIA MEDINA TERON
Title or Position: PCP
Credential: APRN
Phone: 305-264-9767