Healthcare Provider Details

I. General information

NPI: 1972571727
Provider Name (Legal Business Name): MARC E FERNANDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2456 N ESSEX AVE
HERNANDO FL
34442-5321
US

IV. Provider business mailing address

2456 N ESSEX AVE
HERNANDO FL
34442-5321
US

V. Phone/Fax

Practice location:
  • Phone: 352-513-4783
  • Fax: 352-513-4810
Mailing address:
  • Phone: 352-513-4783
  • Fax: 352-513-4810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number39262
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME68189
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: