Provider Demographics
NPI:1528698974
Name:MEDINA, PATRICIA
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3614 BILL PRICE RD
Mailing Address - Street 2:
Mailing Address - City:DEL VALLE
Mailing Address - State:TX
Mailing Address - Zip Code:78617-3630
Mailing Address - Country:US
Mailing Address - Phone:512-854-4193
Mailing Address - Fax:
Practice Address - Street 1:2312 WESTERN TRAILS BLVD STE A102
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1677
Practice Address - Country:US
Practice Address - Phone:512-840-1273
Practice Address - Fax:888-326-4711
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX775428163W00000X
TX1018205363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse