Individual
MISS KIM MARIE MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
13024 CORDELIA LN UNIT 105, ORLANDO, FL 32824-5168
(347) 331-1079
Mailing address
13024 CORDELIA LN UNIT 105, ORLANDO, FL 32824-5168
(347) 331-1079
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
658888
NY
163W00000X
Registered Nurse
Primary
RN9541541
FL
363LP0200X
Pediatric Nurse Practitioner
APRN11044480
FL
Other
Enumeration date
08/28/2012
Last updated
01/16/2026
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