MEDICARE: FERNANDO JOSE VELASQUEZ 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	208000000X	Pediatrics Physician	ME39936	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00293	OTHER	FL	STAY WELL WELL CARE
2	2054	OTHER	FL	HUMANA HMO
3	53640	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1982672713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FERNANDO JOSE VELASQUEZ MD

Provider Business Mailing Address
First Line	:	1523 HIGH KNOLL DR
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511
Country	:	US
Telephone Number	:	813-657-8050
Fax Number	:	813-876-0336

Provider Business Practice Location Address
First Line	:	2906 W TAMPA BAY BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-1233
Country	:	US
Telephone Number	:	813-879-1985
Fax Number	:	813-876-0336

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	12/14/2025

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