MEDICARE: MRS. BRIANNE MEDINA RN, FNP

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	163W00000X	Registered Nurse	760321	CA
2	363LF0000X	Family Nurse Practitioner	95004897	CA

General Provider Information

NPI Number	:	1326594219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRIANNE MEDINA RN, FNP

Provider Business Mailing Address
First Line	:	20 VISTA REAL DR
Second Line	:	ROLLING HILLS ESTATES
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-4227
Country	:	US
Telephone Number	:	310-539-2280
Fax Number	:	310-539-1188

Provider Business Practice Location Address
First Line	:	1505 WILSON TER STE 250
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91206-4075
Country	:	US
Telephone Number	:	818-246-7115
Fax Number	:	877-366-1148

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

Provider Enumeration Date	:	08/30/2016
Last Update Date	:	09/17/2021

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