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NPI Code Detail

MEDICARE: MS. SALLY MEDINA P.A.

MEDICARE: MS. SALLY MEDINA P.A.
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
1363A00000XPhysician AssistantPA3473FL

General Provider Information

NPI Number : 1982706081
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SALLY MEDINA P.A.
Provider Business Mailing Address
First Line : 861 SW 78TH AVE
Second Line :
City : PLANTATION
State : FL
Zip : 33324-3273
Country : US
Telephone Number : 954-693-0000
Fax Number : 954-693-0005
Provider Business Practice Location Address
First Line : 13100 FORT KING RD
Second Line : EMERGENCY DEPARTMENT
City : DADE CITY
State : FL
Zip : 33525-5294
Country : US
Telephone Number : 352-521-1100
Fax Number : 352-521-1169
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2006
Last Update Date : 07/08/2007

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Directions to “ MS. SALLY MEDINA P.A.” Practice Location

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