Healthcare Provider Details

I. General information

NPI: 1598914871
Provider Name (Legal Business Name): CAROLINA FERNANDEZ PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLINA FERNANDEZ PA

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 LAKEVIEW DR APT 101
WESTON FL
33326-2565
US

IV. Provider business mailing address

191 LAKEVIEW DR APT 101
WESTON FL
33326-2565
US

V. Phone/Fax

Practice location:
  • Phone: 954-809-1497
  • Fax:
Mailing address:
  • Phone: 954-809-1497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number031259
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9104757
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: