Provider Demographics
NPI:1285308957
Name:SANCHEZ-MEDINA, EMILIO
Entity type:Individual
Prefix:
First Name:EMILIO
Middle Name:
Last Name:SANCHEZ-MEDINA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 SOUTHGATE COMMERCE BLVD STE 34
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-8550
Mailing Address - Country:US
Mailing Address - Phone:407-423-5178
Mailing Address - Fax:
Practice Address - Street 1:3160 SOUTHGATE COMMERCE BLVD STE 34
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-8550
Practice Address - Country:US
Practice Address - Phone:407-423-5178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2021-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11014289363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily