Provider Demographics
NPI:1316473614
Name:MEDINA, PURA E (APRN)
Entity type:Individual
Prefix:
First Name:PURA
Middle Name:E
Last Name:MEDINA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2924 W 68TH PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-5362
Mailing Address - Country:US
Mailing Address - Phone:786-991-8143
Mailing Address - Fax:
Practice Address - Street 1:1400 NE MIAMI GARDENS DR STE 105
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-4843
Practice Address - Country:US
Practice Address - Phone:786-610-3730
Practice Address - Fax:786-610-3919
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-05
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9305335363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily