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General NPI Number Information
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NPI Number | 1184186918
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Entity Type | Individual
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Provider Name | YUKO MEDINA
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Gender | Female
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Dates
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Enumeration Date | 04/01/2019
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Last Update Date | 04/01/2019
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Provider Practice Location Address
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Address Line | 3012 E HEBRON PKWY STE 104
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City | CARROLLTON
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State | TX
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Zip | 75010-4461
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Country | US
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Telephone | 972-306-0808
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Fax |
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Provider Business Mailing Address
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Address Line | 3500 HORACE AVE
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City | FORT WORTH
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State | TX
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Zip | 76244-8662
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Country | US
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Telephone | 404-694-4674
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN167114
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP141201
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License Number State | TX
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