Provider Demographics
NPI:1881168359
Name:REY MEDINA, ANA LUISA (APRN FNP-BC)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:LUISA
Last Name:REY MEDINA
Suffix:
Gender:F
Credentials:APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6710 OSAGE CIR
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33413-3479
Mailing Address - Country:US
Mailing Address - Phone:305-713-5796
Mailing Address - Fax:
Practice Address - Street 1:4623 FOREST HILL BLVD STE 112
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-9121
Practice Address - Country:US
Practice Address - Phone:561-433-0080
Practice Address - Fax:561-433-1668
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11000458363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherN/A