Provider Demographics
NPI:1215354774
Name:DENIS-MEDINA, ALEX (ARNP)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:DENIS-MEDINA
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9009 CORPORATE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-2367
Mailing Address - Country:US
Mailing Address - Phone:941-773-9781
Mailing Address - Fax:
Practice Address - Street 1:9009 CORPORATE LAKE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-2367
Practice Address - Country:US
Practice Address - Phone:941-773-9781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-23
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9312332363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9312332OtherARNP LICENSE