Healthcare Provider Details

I. General information

NPI: 1124963822
Provider Name (Legal Business Name): PATRICE C FERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5479 CASSIDY LN
AVE MARIA FL
34142-5107
US

IV. Provider business mailing address

PO BOX 3586
LAWRENCE KS
66046-0586
US

V. Phone/Fax

Practice location:
  • Phone: 239-427-2394
  • Fax:
Mailing address:
  • Phone: 239-427-2394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number20845
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13937
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: