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General NPI Number Information
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NPI Number | 1396394581
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Entity Type | Individual
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Provider Name | NIZEL FERNANDEZ
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Gender | Female
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Dates
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Enumeration Date | 09/10/2019
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 1530 CELEBRATION BLVD STE 405
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City | CELEBRATION
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State | FL
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Zip | 34747-5165
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Country | US
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Telephone | 833-769-3524
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Fax |
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Provider Business Mailing Address
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Address Line | 10014 N DALE MABRY HWY STE C-100
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City | TAMPA
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State | FL
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Zip | 33618-4426
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Country | US
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Telephone |
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH16558
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License Number State | FL
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