Healthcare Provider Details

I. General information

NPI: 1407669955
Provider Name (Legal Business Name): JULLISSA THAIS FERNANDEZ MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 01/29/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 191227
SAN JUAN PR
00919-1227
US

IV. Provider business mailing address

ALTURAS DE FLAMBOYAN C-8 CALLE 6
BAYAMON PR
00959-8140
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2000
  • Fax:
Mailing address:
  • Phone: 787-565-3750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number85298
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: