MEDICARE: DR. JUAN CARLOS FERNANDEZ MD

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
1	208D00000X	General Practice Physician	4301119074	MI
2	208D00000X	General Practice Physician	ACN258	FL
3	208D00000X	General Practice Physician	16640	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4301119074	OTHER	MI	OTHER
2	16640	OTHER	PR	MEDICAL LICENSE
3	ACN258	OTHER	FL	ACN MEDICAL LICENSE

General Provider Information

NPI Number	:	1275656449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN CARLOS FERNANDEZ MD

Provider Business Mailing Address
First Line	:	11031 US HIGHWAY 19 STE 102
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-2213
Country	:	US
Telephone Number	:	813-488-4801
Fax Number	:	--

Provider Business Practice Location Address
First Line	:	11031 US HIGHWAY 19 STE 102
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-2213
Country	:	US
Telephone Number	:	813-488-4801
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	02/02/2026

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Directions to “ DR. JUAN CARLOS FERNANDEZ MD” Practice Location

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