Provider Demographics
NPI:1386314938
Name:ACEVEDO MEDINA, JOERIK (RN)
Entity type:Individual
Prefix:
First Name:JOERIK
Middle Name:
Last Name:ACEVEDO MEDINA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12200 MENTA ST STE 105
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-7540
Mailing Address - Country:US
Mailing Address - Phone:407-757-2257
Mailing Address - Fax:407-845-1102
Practice Address - Street 1:12200 MENTA ST STE 105
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-7540
Practice Address - Country:US
Practice Address - Phone:407-757-2257
Practice Address - Fax:407-845-1102
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9376564163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics