Healthcare Provider Details

I. General information

NPI: 1750055422
Provider Name (Legal Business Name): JACQUELINE FERNANDEZ RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2021
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14775 SW 168TH TER
MIAMI FL
33187-1759
US

IV. Provider business mailing address

14775 SW 168TH TER
MIAMI FL
33187-1759
US

V. Phone/Fax

Practice location:
  • Phone: 502-650-1100
  • Fax:
Mailing address:
  • Phone: 502-650-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-119352
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: