Healthcare Provider Details

I. General information

NPI: 1164262101
Provider Name (Legal Business Name): DACIA FERNANDEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 GIROD ST APT 22G
NEW ORLEANS LA
70113-1267
US

IV. Provider business mailing address

1100 GIROD ST APT 22G
NEW ORLEANS LA
70113-1267
US

V. Phone/Fax

Practice location:
  • Phone: 504-292-3045
  • Fax:
Mailing address:
  • Phone: 504-292-3045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209513
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number209513
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number209513
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: