Healthcare Provider Details

I. General information

NPI: 1174025720
Provider Name (Legal Business Name): FERNANDEZ UPPER EXTREMITY INSTITUTE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 GOODLETTE FRANK RD N STE 204
NAPLES FL
34102-5618
US

IV. Provider business mailing address

730 GOODLETTE FRANK ROAD N STE 204
NAPLES FL
34102-5618
US

V. Phone/Fax

Practice location:
  • Phone: 239-777-9321
  • Fax:
Mailing address:
  • Phone: 239-337-2003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME126810
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberME126810
License Number StateFL

VIII. Authorized Official

Name: CARMELLA FERNANDEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 239-337-2003