Healthcare Provider Details

I. General information

NPI: 1114922960
Provider Name (Legal Business Name): ESTHER CAMMACK FERNANDEZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 MEDICAL PARK DR STE 320
TAMPA FL
33613-4681
US

IV. Provider business mailing address

3000 MEDICAL PARK DR STE 320
TAMPA FL
33613-4681
US

V. Phone/Fax

Practice location:
  • Phone: 813-910-0027
  • Fax: 813-971-1286
Mailing address:
  • Phone: 813-910-0027
  • Fax: 813-971-1286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN1560232
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: