Healthcare Provider Details

I. General information

NPI: 1801158860
Provider Name (Legal Business Name): JOSANN FERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1858 N ALAFAYA TRL
ORLANDO FL
32826-4728
US

IV. Provider business mailing address

3018 HYDRUS DR
ORLANDO FL
32828-9329
US

V. Phone/Fax

Practice location:
  • Phone: 407-900-5313
  • Fax:
Mailing address:
  • Phone: 407-341-3636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: