Healthcare Provider Details

I. General information

NPI: 1750216685
Provider Name (Legal Business Name): NICOLE MARIE FERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2666 TIGERTAIL AVE APT 109
COCONUT GROVE FL
33133-4651
US

IV. Provider business mailing address

2666 TIGERTAIL AVE APT 109
COCONUT GROVE FL
33133-4651
US

V. Phone/Fax

Practice location:
  • Phone: 305-778-9853
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number9661046
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: