Healthcare Provider Details

I. General information

NPI: 1114741980
Provider Name (Legal Business Name): FREDDY RICARDO VARONA FERNANDEZ P.A.F.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2024
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MARYLAND FARMS STE 200
BRENTWOOD TN
37027-5780
US

IV. Provider business mailing address

11750 SW 40TH ST
MIAMI FL
33175-3530
US

V. Phone/Fax

Practice location:
  • Phone: 800-348-4565
  • Fax:
Mailing address:
  • Phone: 305-223-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2862
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number24-363
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2862
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: