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General NPI Number Information
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NPI Number | 1639678899
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Entity Type | Individual
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Provider Name | IVETTE MEDRANO APRN, PMHNP-BC, DNP
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Gender | Female
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Dates
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Enumeration Date | 02/02/2018
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Last Update Date | 09/06/2025
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Provider Practice Location Address
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Address Line | 7901 4TH ST N # 23125
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City | ST PETERSBURG
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State | FL
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Zip | 33702-4305
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Country | US
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Telephone | 786-592-0331
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Fax |
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Provider Business Mailing Address
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Address Line | 7901 4TH ST N STE 23125
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City | ST PETERSBURG
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State | FL
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Zip | 33702-4305
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Country | US
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Telephone | 727-210-5589
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Fax | 833-605-4098
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 11004085
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License Number State | FL
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