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General NPI Number Information
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NPI Number | 1972970481
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Entity Type | Organization
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Legal Business Name | DIANNE M FERNANDEZ DC PA
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Dates
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Enumeration Date | 09/01/2015
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Last Update Date | 09/01/2015
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Provider Practice Location Address
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Address Line | 6166 SEMINOLE BLVD
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City | SEMINOLE
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State | FL
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Zip | 33772-6835
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Country | US
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Telephone | 727-280-2323
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Fax | 727-201-4988
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Provider Business Mailing Address
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Address Line | 6166 SEMINOLE BLVD
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City | SEMINOLE
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State | FL
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Zip | 33772-6835
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Country | US
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Telephone | 727-280-2323
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Fax | 727-201-4988
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Authorized Official
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Title or Position | PRES/OWNER
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Name | DR. DIANNE MICHELLE FERNANDEZ
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Credential | DC
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Telephone | 727-280-2323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5777
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License Number State | FL
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