MEDICARE: CARLA ALISON MEDINA MARTINEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	2025045459	TX

General Provider Information

NPI Number	:	1245194174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA ALISON MEDINA MARTINEZ

Provider Business Mailing Address
First Line	:	4521 VANCE RD
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-8161
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4521 VANCE RD
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-8161
Country	:	US
Telephone Number	:	913-808-7307
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	05/20/2026

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