Individual
JOSE MIGUEL MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1009 NOVUS DR STE 2, JOHNSON CITY, TN 37604-8237
(423) 283-0776
(423) 283-0549
Mailing address
1009 NOVUS DR STE 2, JOHNSON CITY, TN 37604-8237
(423) 283-0776
(423) 283-0549
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
14033
TN
367500000X
Certified Registered Nurse Anesthetist
26564
SC
367500000X
Certified Registered Nurse Anesthetist
Primary
APN14033
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1532093
—
TN
05
—
AN3780
—
SC
Enumeration date
03/18/2009
Last updated
10/20/2022
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