Healthcare Provider Details

I. General information

NPI: 1205674355
Provider Name (Legal Business Name): GEORGE EDWARD FERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 9TH ST N STE 300
NAPLES FL
34102-5820
US

IV. Provider business mailing address

3051 SW 27TH AVE APT 502
MIAMI FL
33133-4615
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-4200
  • Fax: 239-624-4241
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11033952
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11033952
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: