Provider Demographics
NPI:1710721956
Name:MEDINA, TANAIRY
Entity type:Individual
Prefix:
First Name:TANAIRY
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 SANDY CREEK LN
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-1492
Mailing Address - Country:US
Mailing Address - Phone:407-952-7027
Mailing Address - Fax:
Practice Address - Street 1:2506 SANDY CREEK LN
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-1492
Practice Address - Country:US
Practice Address - Phone:407-952-7027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-22
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator