Healthcare Provider Details

I. General information

NPI: 1376298430
Provider Name (Legal Business Name): NOHEMI FERNANDEZ RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2022
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3070 E COLLEGE AVE
RUSKIN FL
33570-5220
US

IV. Provider business mailing address

3070 E COLLEGE AVE
RUSKIN FL
33570-5220
US

V. Phone/Fax

Practice location:
  • Phone: 813-641-2945
  • Fax: 813-641-9746
Mailing address:
  • Phone: 813-641-2945
  • Fax: 813-641-9746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH11532
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: