Provider Demographics
NPI:1033080353
Name:MEDINA, TERRIANN LORRAINE (CAPRC)
Entity type:Individual
Prefix:
First Name:TERRIANN
Middle Name:LORRAINE
Last Name:MEDINA
Suffix:
Gender:M
Credentials:CAPRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13699 US 50
Mailing Address - Street 2:
Mailing Address - City:DILLSBORO
Mailing Address - State:IN
Mailing Address - Zip Code:47018-9642
Mailing Address - Country:US
Mailing Address - Phone:812-621-2481
Mailing Address - Fax:
Practice Address - Street 1:13699 US 50
Practice Address - Street 2:
Practice Address - City:DILLSBORO
Practice Address - State:IN
Practice Address - Zip Code:47018-9642
Practice Address - Country:US
Practice Address - Phone:812-621-2481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN190004897172V00000X
INCAPRC2-5662175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No172V00000XOther Service ProvidersCommunity Health Worker