Individual
DIANA MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
2700 GLADES CIR STE 136, WESTON, FL 33327-2210
(954) 738-2512
(865) 409-5715
Mailing address
2700 GLADES CIR STE 136, WESTON, FL 33327-2210
(954) 738-2512
(865) 409-5715
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA67616
CA
363A00000X
Physician Assistant
Primary
PA9108228
FL
363A00000X
Physician Assistant
PAT9108228
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
013309400
—
FL
01
—
KP511
MEDICARE
FL
01
—
Y0R3E
BCBS
FL
Enumeration date
09/12/2014
Last updated
01/27/2026
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