Healthcare Provider Details

I. General information

NPI: 1992417414
Provider Name (Legal Business Name): MICHELLE FERNANDEZ REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2022
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18255 HOMESTEAD AVE
MIAMI FL
33157-5564
US

IV. Provider business mailing address

8175 NW 12TH ST STE 306
DORAL FL
33126-1828
US

V. Phone/Fax

Practice location:
  • Phone: 305-575-3800
  • Fax:
Mailing address:
  • Phone: 305-575-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN9213318
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: