Healthcare Provider Details

I. General information

NPI: 1497337422
Provider Name (Legal Business Name): MICHEL FERNANDEZ MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 FRUIT COVE RD
ST JOHNS FL
32259-3149
US

IV. Provider business mailing address

924 FRUIT COVE RD
ST JOHNS FL
32259-3149
US

V. Phone/Fax

Practice location:
  • Phone: 817-907-9550
  • Fax:
Mailing address:
  • Phone: 817-907-9550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHEL FERNANDEZ
Title or Position: OWNER
Credential: MD
Phone: 817-907-9550