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General NPI Number Information
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NPI Number | 1407669955
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Entity Type | Individual
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Provider Name | JULLISSA THAIS FERNANDEZ MSN
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Gender | Female
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Dates
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Enumeration Date | 01/29/2025
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | PO BOX 191227
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City | SAN JUAN
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State | PR
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Zip | 00919-1227
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Country | US
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Telephone | 787-758-2000
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Fax |
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Provider Business Mailing Address
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Address Line | ALTURAS DE FLAMBOYAN C-8 CALLE 6
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City | BAYAMON
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State | PR
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Zip | 00959-8140
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Country | US
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Telephone | 787-565-3750
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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 | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | 85298
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License Number State | PR
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