Healthcare Provider Details

I. General information

NPI: 1982665279
Provider Name (Legal Business Name): KRISTIN P. FERNANDEZ D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14534 OLD SAINT AUGUSTINE RD STE 3430
JACKSONVILLE FL
32258-2645
US

IV. Provider business mailing address

PO BOX 748817
ATLANTA GA
30374-8817
US

V. Phone/Fax

Practice location:
  • Phone: 904-268-5300
  • Fax: 904-268-5040
Mailing address:
  • Phone: 813-286-0033
  • Fax: 813-282-1806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberOS7697
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: