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General NPI Number Information
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NPI Number | 1477935831
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Entity Type | Individual
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Provider Name | DENISSE MEDINA
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Gender | Female
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Dates
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Enumeration Date | 06/22/2015
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 4898 E IRLO BRONSON MEMORIAL HWY
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City | SAINT CLOUD
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State | FL
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Zip | 34771-8714
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Country | US
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Telephone | 407-891-3054
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Fax |
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Provider Business Mailing Address
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Address Line | 4824 LAKE SHORE DR
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City | SAINT CLOUD
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State | FL
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Zip | 34772-8455
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Country | US
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Telephone |
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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