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General NPI Number Information
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NPI Number | 1316473614
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Entity Type | Individual
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Provider Name | PURA E MEDINA APRN
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Gender | Female
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Dates
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Enumeration Date | 05/05/2017
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 1400 NE MIAMI GARDENS DR STE 105
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33179-4843
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Country | US
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Telephone | 786-610-3730
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Fax | 786-610-3919
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Provider Business Mailing Address
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Address Line | 2924 W 68TH PL
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City | HIALEAH
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State | FL
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Zip | 33018-5362
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Country | US
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Telephone | 786-991-8143
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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 | 9305335
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License Number State | FL
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