MEDICARE: DR. JUAN CARLOS FERNANDEZ MD

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	208D00000X	General Practice Physician	ACN258	FL
2	208D00000X	General Practice Physician	16640	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	16640	OTHER	PR	MEDICAL LICENSE
2	ACN258	OTHER	FL	ACN MEDICAL LICENSE

General Provider Information

NPI Number	:	1275656449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN CARLOS FERNANDEZ MD

Provider Business Mailing Address
First Line	:	4160 N ARMENIA AVE STE A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6453
Country	:	US
Telephone Number	:	855-226-6633
Fax Number	:	866-285-7068

Provider Business Practice Location Address
First Line	:	4160 N ARMENIA AVE STE A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6453
Country	:	US
Telephone Number	:	855-226-6633
Fax Number	:	866-285-7068

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	03/05/2024

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Directions to “ DR. JUAN CARLOS FERNANDEZ MD” Practice Location

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