Provider Demographics
NPI:1215439922
Name:MEDINA, PATRICIA ANN (ARNP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:MEDINA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7223 67TH AVE W
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-8330
Mailing Address - Country:US
Mailing Address - Phone:253-212-7787
Mailing Address - Fax:
Practice Address - Street 1:3402 S 19TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2487
Practice Address - Country:US
Practice Address - Phone:253-301-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10007229363L00000X
CA95031444363L00000X
WAAP60838565363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner