Healthcare Provider Details

I. General information

NPI: 1972068351
Provider Name (Legal Business Name): IDIA FERNANDEZ GIL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2019
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7737 N UNIVERSITY DR STE 107
TAMARAC FL
33321-2968
US

IV. Provider business mailing address

7737 N UNIVERSITY DR STE 107
TAMARAC FL
33321-2968
US

V. Phone/Fax

Practice location:
  • Phone: 954-720-0056
  • Fax: 954-721-4120
Mailing address:
  • Phone: 954-720-0056
  • Fax: 954-721-4120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9338020
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: