Healthcare Provider Details

I. General information

NPI: 1346873973
Provider Name (Legal Business Name): ROXANY FERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2020
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 BEACH RD APT 3B
BAXLEY GA
31513-9273
US

IV. Provider business mailing address

609 BEACH RD APT 3B
BAXLEY GA
31513-9273
US

V. Phone/Fax

Practice location:
  • Phone: 305-215-3655
  • Fax:
Mailing address:
  • Phone: 305-215-3655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA003005
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number29647
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: