Healthcare Provider Details

I. General information

NPI: 1699273532
Provider Name (Legal Business Name): MARLENE FERNANDEZ PA-C, MPAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARLENE RODRIGUEZ PA-C, MPAS

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 W MILLER ST
ORLANDO FL
32806-2032
US

IV. Provider business mailing address

92 W MILLER ST FL 7
ORLANDO FL
32806-2032
US

V. Phone/Fax

Practice location:
  • Phone: 407-649-9111
  • Fax:
Mailing address:
  • Phone: 321-842-6671
  • Fax: 321-843-6447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9111302
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9111302
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: