MEDICARE: JESSICA FERNANDEZ PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9116598	FL

General Provider Information

NPI Number	:	1124616420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA FERNANDEZ PA

Provider Business Mailing Address
First Line	:	624 SE 6TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-3407
Country	:	US
Telephone Number	:	954-262-1250
Fax Number	:

Provider Business Practice Location Address
First Line	:	624 SE 6TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-3407
Country	:	US
Telephone Number	:	954-826-0926
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2021
Last Update Date	:	08/29/2024

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Directions to “ JESSICA FERNANDEZ PA” Practice Location

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