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General NPI Number Information
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NPI Number | 1477876811
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Entity Type | Individual
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Provider Name | DEANNA S. FERNANDEZ CRNA
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Gender | Female
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Dates
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Enumeration Date | 03/11/2010
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Last Update Date | 09/21/2021
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Provider Practice Location Address
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Address Line | 15190 COMMUNITY RD SUITE 230A
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City | GULFPORT
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State | MS
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Zip | 39503-3485
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Country | US
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Telephone | 228-831-0204
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Fax | 228-831-1868
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Provider Business Mailing Address
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Address Line | 15190 COMMUNITY RD SUITE 230A
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City | GULFPORT
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State | MS
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Zip | 39503-3485
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Country | US
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Telephone | 228-831-0204
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Fax | 228-831-1868
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | R861629
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License Number State | MS
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