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NPI Code Detail

MEDICARE: MS. CARMEN MARIA FERNANDEZ D.O

MEDICARE: MS. CARMEN MARIA FERNANDEZ D.O
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianOS12773FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1FGU25OTHERFLORIDA BLUE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093121089
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CARMEN MARIA FERNANDEZ D.O
Provider Business Mailing Address
First Line : 2675 WINKLER AVE FL 2
Second Line :
City : FORT MYERS
State : FL
Zip : 33901-9342
Country : US
Telephone Number : 877-856-3774
Fax Number :
Provider Business Practice Location Address
First Line : 13214 PALM BEACH BLVD
Second Line :
City : FORT MYERS
State : FL
Zip : 33905-2025
Country : US
Telephone Number : 239-694-7887
Fax Number : 239-694-8941
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2014
Last Update Date : 06/07/2024

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