1. Home
  2. Directory
  3. Florida
  4. Fort Myers
  5. Physician Assistant
  6. NPI Profile

MR. OTTO R MEDINILLA JR. PAC
NPI 1649259540
Physician Assistant in Fort Myers, FL

Active since January 10, 2006
11300 LINDBERGH BLVD STE 115, FORT MYERS, FL 33913(239) 245-8600(239) 245-8660 Get Directions Write a Review

NPPES record last updated: December 1, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mr. Otto R Medinilla Jr. Pac NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. OTTO R MEDINILLA JR. PAC (NPI 1649259540) is an individual physician assistant in Fort Myers, Florida, licensed in Delaware (C50000198) and active in the NPI registry since January 2006.

NPPES Registry Identity

NPI1649259540
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameMR. OTTO R MEDINILLA JR.Credential: PAC
Location Address11300 LINDBERGH BLVD STE 115Fort Myers, FL 33913-8827
Mailing AddressPo Box 3048Wilmington, DE 19804 · (302) 224-5678 · Fax (302) 224-2848
Phone(239) 245-8600
Fax(239) 245-8660
Sole ProprietorYes
Enumeration DateJanuary 10, 2006
Last NPPES UpdateDecember 1, 2020
NPPES CertifiedDecember 1, 2020
✔ NPI 1649259540 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in DE · C50000198
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
11300 LINDBERGH BLVD STE 115, Fort Myers, FL 33913
Open in Google Maps ↗

Other Identifiers 1

Medicaid1000036903DE

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Otto Medinilla's NPI number?

The NPI number for Otto Medinilla is 1649259540. It was assigned to this individual provider in the NPPES registry on January 10, 2006.

Where is Otto Medinilla located?

Otto Medinilla practices at 11300 Lindbergh Blvd Ste 115, Fort Myers, FL 33913. The listed phone number is (239) 245-8600.

What is Otto Medinilla's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

When was this NPI record last updated?

The NPPES record for Otto Medinilla was last updated on December 1, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.