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NPI Code Detail

MEDICARE: MRS. TATIANA B FERNANDES RPH

MEDICARE: MRS. TATIANA B FERNANDES RPH
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
1183500000XPharmacistPS60340FL

General Provider Information

NPI Number : 1578176814
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TATIANA B FERNANDES RPH
Provider Business Mailing Address
First Line : 6370 BAYSHORE RD
Second Line :
City : NORTH FORT MYERS
State : FL
Zip : 33917-3137
Country : US
Telephone Number : 239-656-1424
Fax Number :
Provider Business Practice Location Address
First Line : 6370 BAYSHORE RD
Second Line :
City : NORTH FORT MYERS
State : FL
Zip : 33917-3137
Country : US
Telephone Number : 239-656-1424
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2020
Last Update Date : 08/26/2020

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