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General NPI Number Information
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NPI Number | 1780449454
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Entity Type | Individual
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Provider Name | DAMISELA FERNANDEZ CRUZ FNP
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Gender | Female
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Dates
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Enumeration Date | 02/20/2024
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Last Update Date | 02/24/2024
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Provider Practice Location Address
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Address Line | 5431 NW 186TH ST
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City | MIAMI GARDENS
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State | FL
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Zip | 33055-5348
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Country | US
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Telephone | 786-718-7874
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Fax |
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Provider Business Mailing Address
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Address Line | 5431 NW 186TH ST
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City | MIAMI GARDENS
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State | FL
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Zip | 33055-5348
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Country | US
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Telephone | 786-718-7874
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F02240598
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License Number State | FL
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