Healthcare Provider Details

I. General information

NPI: 1497373898
Provider Name (Legal Business Name): NATALIE FERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2020
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 SE HILLMOOR DR STE B101-103
PORT SAINT LUCIE FL
34952-7553
US

IV. Provider business mailing address

557 NW FAIRFAX AVE
PORT ST LUCIE FL
34983-1017
US

V. Phone/Fax

Practice location:
  • Phone: 772-463-0444
  • Fax:
Mailing address:
  • Phone: 561-707-2829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-86575
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: