Healthcare Provider Details

I. General information

NPI: 1164233805
Provider Name (Legal Business Name): SONIA MEDINA NUNEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 W LAMBRIGHT ST STE 103
TAMPA FL
33614-4750
US

IV. Provider business mailing address

3430 W LAMBRIGHT ST STE 103
TAMPA FL
33614-4750
US

V. Phone/Fax

Practice location:
  • Phone: 813-512-6164
  • Fax: 813-872-7207
Mailing address:
  • Phone: 813-512-6164
  • Fax: 813-872-7207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number9667427
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: