Healthcare Provider Details

I. General information

NPI: 1346481165
Provider Name (Legal Business Name): ALLISON MANUELA FERNANDEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2009
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 5TH ST S
ST PETERSBURG FL
33701-4804
US

IV. Provider business mailing address

175 1ST ST S APT 2706
ST PETERSBURG FL
33701-4520
US

V. Phone/Fax

Practice location:
  • Phone: 727-767-8480
  • Fax:
Mailing address:
  • Phone: 917-754-0050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME114086
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberME114086
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: