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General NPI Number Information
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NPI Number | 1720911753
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Entity Type | Individual
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Provider Name | CARLOS MANUEL FERNANDEZ JR.
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Gender | Male
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Dates
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Enumeration Date | 06/08/2026
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Last Update Date | 06/08/2026
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Provider Practice Location Address
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Address Line | 851 TRAFALGAR CT STE 200E
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City | MAITLAND
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State | FL
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Zip | 32751-7420
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Country | US
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Telephone | 888-339-8727
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Fax |
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Provider Business Mailing Address
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Address Line | 136 LUMA PL
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City | CASSELBERRY
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State | FL
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Zip | 32707-3299
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Country | US
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Telephone | 786-765-9053
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN9439646
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License Number State | FL
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