Provider Demographics
NPI:1073009056
Name:MEDINA PAEZ, JEANNIE PAOLA (MD)
Entity type:Individual
Prefix:
First Name:JEANNIE
Middle Name:PAOLA
Last Name:MEDINA PAEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3274 GREENWALD WAY N
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-0728
Mailing Address - Country:US
Mailing Address - Phone:407-249-1234
Mailing Address - Fax:
Practice Address - Street 1:3274 GREENWALD WAY N
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-0728
Practice Address - Country:US
Practice Address - Phone:407-249-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME147502208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program