Provider Demographics
NPI:1154573525
Name:MILAGROS MEDINA APRN BC PA
Entity type:Organization
Organization Name:MILAGROS MEDINA APRN BC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MILAGROS
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:305-607-9607
Mailing Address - Street 1:PO BOX 901231
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33090-1231
Mailing Address - Country:US
Mailing Address - Phone:305-607-9607
Mailing Address - Fax:305-245-9933
Practice Address - Street 1:9745 SUNSET DR
Practice Address - Street 2:SUITE 107
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-4652
Practice Address - Country:US
Practice Address - Phone:305-271-1148
Practice Address - Fax:305-271-1112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9165584363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty