Healthcare Provider Details

I. General information

NPI: 1346708203
Provider Name (Legal Business Name): JUAN CARLOS FERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2019
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9131 COLLEGE POINTE CT
FORT MYERS FL
33919-3245
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-9100
  • Fax:
Mailing address:
  • Phone: 239-343-9100
  • Fax: 239-343-9180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME170609
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: