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General NPI Number Information
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NPI Number | 1619735701
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Entity Type | Individual
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Provider Name | JOSE L MEDINA SR. ARNP F03240384
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Gender | Male
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Dates
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Enumeration Date | 03/12/2024
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 1580 SANTA BARBARA BLVD
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City | THE VILLAGES
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State | FL
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Zip | 32159-6827
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Country | US
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Telephone | 352-259-2159
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Fax | 352-259-5731
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Provider Business Mailing Address
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Address Line | 1580 SANTA BARBARA BLVD
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City | THE VILLAGES
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State | FL
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Zip | 32159-6827
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Country | US
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Telephone | 352-259-2159
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Fax | 352-259-5731
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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 | F0320384
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License Number State | FL
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