=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417493081
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | INGRID FERNANDEZ ARNP-FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2017
-----------------------------------------------------
Last Update Date | 05/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2200 OSPREY BLVD
-----------------------------------------------------
City | BARTOW
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33830-3308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-533-8111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 563 SANCTUARY BLVD
-----------------------------------------------------
City | WINTER HAVEN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33881-9514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-780-5550
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 9264146
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------