Provider Demographics
NPI:1073173118
Name:MEDINA PENA, ANGELICA (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELICA
Middle Name:
Last Name:MEDINA PENA
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 1:150 SE 17TH ST STE 801
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-7100
Mailing Address - Country:US
Mailing Address - Phone:352-240-8555
Mailing Address - Fax:
Practice Address - Street 1:150 SE 17TH ST STE 801
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7100
Practice Address - Country:US
Practice Address - Phone:352-240-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME166359207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program