Healthcare Provider Details

I. General information

NPI: 1396394581
Provider Name (Legal Business Name): NIZEL FERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 CELEBRATION BLVD STE 405
CELEBRATION FL
34747-5165
US

IV. Provider business mailing address

10014 N DALE MABRY HWY STE C-100
TAMPA FL
33618-4426
US

V. Phone/Fax

Practice location:
  • Phone: 833-769-3524
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH16558
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: