Healthcare Provider Details

I. General information

NPI: 1558179580
Provider Name (Legal Business Name): LAUREANO FERNANDEZ JR. RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 12/23/2024
Certification Date: 12/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 MAJORCA PL APT 2042
ORLANDO FL
32819-5543
US

IV. Provider business mailing address

7600 MAJORCA PL APT 2042
ORLANDO FL
32819-5543
US

V. Phone/Fax

Practice location:
  • Phone: 305-305-0263
  • Fax:
Mailing address:
  • Phone: 305-305-0263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number9576006
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: