Provider Demographics
NPI:1588410351
Name:FIGUEROA MEDINA, BRIANNA R
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:R
Last Name:FIGUEROA 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 1:114 FLORAL DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-1812
Mailing Address - Country:US
Mailing Address - Phone:813-520-2770
Mailing Address - Fax:
Practice Address - Street 1:114 FLORAL DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-1812
Practice Address - Country:US
Practice Address - Phone:813-520-2770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-339762106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician