MEDICARE: NICOLE MARIE FERNANDEZ

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	363LW0102X	Women's Health Nurse Practitioner	9661046	FL

General Provider Information

NPI Number	:	1750216685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MARIE FERNANDEZ

Provider Business Mailing Address
First Line	:	2666 TIGERTAIL AVE APT 109
Second Line	:
City	:	COCONUT GROVE
State	:	FL
Zip	:	33133-4651
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2666 TIGERTAIL AVE APT 109
Second Line	:
City	:	COCONUT GROVE
State	:	FL
Zip	:	33133-4651
Country	:	US
Telephone Number	:	305-778-9853
Fax Number	:

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

Provider Enumeration Date	:	06/13/2026
Last Update Date	:	06/13/2026

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