Provider Demographics
NPI:1972384535
Name:HUSIC, MEDINA (PA-C)
Entity type:Individual
Prefix:
First Name:MEDINA
Middle Name:
Last Name:HUSIC
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MEDINA
Other - Middle Name:
Other - Last Name:METJAIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:12670 CREEKSIDE LN STE 202
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3370
Mailing Address - Country:US
Mailing Address - Phone:904-634-0640
Mailing Address - Fax:
Practice Address - Street 1:8350 RIVERWALK PARK BLVD STE 1
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-8759
Practice Address - Country:US
Practice Address - Phone:239-482-2663
Practice Address - Fax:239-482-7585
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030831363A00000X
FLPA9119959363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant