Healthcare Provider Details

I. General information

NPI: 1114880945
Provider Name (Legal Business Name): ROSANGELA DE LUCA GONCALO FERNANDES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15333 HONEYBELL DR
WINTER GARDEN FL
34787-5061
US

IV. Provider business mailing address

15333 HONEYBELL DR
WINTER GARDEN FL
34787-5061
US

V. Phone/Fax

Practice location:
  • Phone: 407-922-8397
  • Fax:
Mailing address:
  • Phone: 407-922-8397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: