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General NPI Number Information
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NPI Number | 1063866234
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Entity Type | Individual
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Provider Name | DR. LUIS ENRIQUE FERNANDEZ
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Gender | Male
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Dates
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Enumeration Date | 04/14/2016
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 1170 SW BAYSHORE BLVD STE 200
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City | PORT ST LUCIE
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State | FL
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Zip | 34983-2408
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Country | US
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Telephone | 772-309-0020
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Fax | 855-538-3104
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Provider Business Mailing Address
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Address Line | 1170 SW BAYSHORE BLVD STE 200
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City | PORT ST LUCIE
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State | FL
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Zip | 34983-2408
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Country | US
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Telephone | 772-309-0020
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Fax | 855-538-3104
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ACN1761
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 19469
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License Number State | PR
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