Healthcare Provider Details

I. General information

NPI: 1174441745
Provider Name (Legal Business Name): FERNANDO ALEJANDRO PENA FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11145 SW 6TH ST APT 102
PEMBROKE PINES FL
33025-6977
US

IV. Provider business mailing address

11145 SW 6TH ST APT 102
PEMBROKE PINES FL
33025-6977
US

V. Phone/Fax

Practice location:
  • Phone: 954-512-4776
  • Fax:
Mailing address:
  • Phone: 954-512-4776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11048996
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: