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General NPI Number Information
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NPI Number | 1689454241
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Entity Type | Individual
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Provider Name | ROSA MIRNA MEDINA FNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/02/2023
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 8401 MEDICAL PLAZA DR STE 300
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City | CHARLOTTE
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State | NC
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Zip | 28262-8702
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Country | US
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Telephone | 704-316-6561
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Fax |
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Provider Business Mailing Address
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Address Line | 8401 MEDICAL PLAZA DR STE 300
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City | CHARLOTTE
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State | NC
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Zip | 28262-8702
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Country | US
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Telephone | 704-316-6561
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Fax | 704-384-1974
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 331759
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5021474
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License Number State | NC
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