Healthcare Provider Details

I. General information

NPI: 1457021081
Provider Name (Legal Business Name): MAYELIN FERNANDEZ FUENTES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4759 LAKEVIEW DR STE 101
SEBRING FL
33870-2005
US

IV. Provider business mailing address

4759 LAKEVIEW DR STE 101
SEBRING FL
33870-2005
US

V. Phone/Fax

Practice location:
  • Phone: 863-402-5600
  • Fax: 863-402-5602
Mailing address:
  • Phone: 863-402-5600
  • Fax: 638-402-5602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberAPRN11014694
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: