Provider Demographics
NPI:1629803762
Name:MEDINA, IVANA (APRN)
Entity type:Individual
Prefix:MS
First Name:IVANA
Middle Name:
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 1:2252 LELAND LN
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-5393
Mailing Address - Country:US
Mailing Address - Phone:516-643-2856
Mailing Address - Fax:
Practice Address - Street 1:1605 W FAIRBANKS AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4603
Practice Address - Country:US
Practice Address - Phone:407-845-8356
Practice Address - Fax:407-845-8357
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11035051163WC3500X
FLAPRN11035051363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WC3500XNursing Service ProvidersRegistered NurseCardiac Rehabilitation