Provider Demographics
NPI:1285851147
Name:MEDINA MEDINA, PAULA (MD)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:
Last Name:MEDINA MEDINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PAULA
Other - Middle Name:
Other - Last Name:MEDINA MEDINA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:345 S CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-4617
Mailing Address - Country:US
Mailing Address - Phone:561-274-3100
Mailing Address - Fax:561-274-3103
Practice Address - Street 1:515 W 6TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-4324
Practice Address - Country:US
Practice Address - Phone:904-253-1070
Practice Address - Fax:904-253-1943
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14,374146D00000X
FLACN257208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR14,374Medicaid
PR14,374Medicaid