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General NPI Number Information
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NPI Number | 1639711773
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Entity Type | Individual
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Provider Name | JESSICA NICOLE MEDINA RNFA
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Gender | Female
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Dates
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Enumeration Date | 10/10/2019
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Last Update Date | 01/03/2020
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Provider Practice Location Address
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Address Line | 156 W TAHOE DR
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City | SAVANNAH
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State | GA
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Zip | 31405-9421
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Country | US
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Telephone | 760-731-0313
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Fax | 760-731-0414
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Provider Business Mailing Address
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Address Line | 5710 OGEECHEE RD STE 200 PMB 314
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City | SAVANNAH
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State | GA
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Zip | 31405
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Country | US
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Telephone | 760-731-0313
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Fax | 760-731-0414
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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 | 163WR0006X
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Taxonomy Name | Registered Nurse First Assistant
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License Number | RN246577
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License Number State | GA
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