Healthcare Provider Details

I. General information

NPI: 1376450486
Provider Name (Legal Business Name): PRISCILLA FERNANDEZ RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-0325
US

IV. Provider business mailing address

PO BOX 100325
GAINESVILLE FL
32610-0325
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0400
  • Fax:
Mailing address:
  • Phone: 352-265-0400
  • Fax: 352-265-1071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND15321
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: