Healthcare Provider Details

I. General information

NPI: 1790228385
Provider Name (Legal Business Name): ELBA L FERNANDEZ ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2016
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 13TH ST
SAINT CLOUD FL
34769-4454
US

IV. Provider business mailing address

906 13TH ST
SAINT CLOUD FL
34769-4454
US

V. Phone/Fax

Practice location:
  • Phone: 407-593-0145
  • Fax: 407-593-0145
Mailing address:
  • Phone: 407-593-0145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9193472
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: