Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Otto R Medinilla Jr., PAC

Individual provider Physician Assistant · NPI 1649259540

Mr. Otto R Medinilla Jr., PAC is a Physician Assistant in Fort Myers, Florida. Practices as a sole proprietor. Licensed in Delaware.

Licensed in
DE
In the registry since
2006
What do these letters mean?
PAC — Physician Assistant, Certified
A physician assistant holding current national certification; usually written PA-C.

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Practice location Address checks out

11300 Lindbergh Blvd Ste 115
Fort Myers, FL 33913-8827
Phone: (239) 245-8600
Fax: (239) 245-8660
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence C50000198 (DE)

Record details

NPI number1649259540
Entity typeIndividual (Type 1)
GenderMale
Credentials PAC
Sole proprietorYes
NPI enumeratedJanuary 10, 2006
Last updated in NPPESDecember 1, 2020
Certification dateDecember 1, 2020

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