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General NPI Number Information
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NPI Number | 1295534782
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Entity Type | Individual
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Provider Name | MEDINA TAN FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/10/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 3753 HOWARD HUGHES PKWY STE 200
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City | LAS VEGAS
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State | NV
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Zip | 89169-0952
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Country | US
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Telephone | 502-320-0023
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Fax | 949-281-5550
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Provider Business Mailing Address
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Address Line | 6655 W SAHARA AVE STE A218
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City | LAS VEGAS
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State | NV
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Zip | 89146-0847
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Country | US
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Telephone | 725-205-2457
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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 | 848581
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License Number State | NV
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