Healthcare Provider Details

I. General information

NPI: 1952441040
Provider Name (Legal Business Name): JACQUELINE FERNANDEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 NE 8TH ST
HOMESTEAD FL
33033-4505
US

IV. Provider business mailing address

8601 SW 124TH AVE
MIAMI FL
33183-4601
US

V. Phone/Fax

Practice location:
  • Phone: 305-289-8272
  • Fax: 305-938-0770
Mailing address:
  • Phone: 305-878-0393
  • Fax: 305-675-0231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME84873
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: