Healthcare Provider Details

I. General information

NPI: 1235044082
Provider Name (Legal Business Name): FERNANDO JOSE CORREDOR FANJUL APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2341 SE 27TH DR
HOMESTEAD FL
33035-2015
US

IV. Provider business mailing address

2341 SE 27TH DR
HOMESTEAD FL
33035-2015
US

V. Phone/Fax

Practice location:
  • Phone: 305-989-6459
  • Fax:
Mailing address:
  • Phone: 305-989-6459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11050063
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: