MEDICARE: ROSA FERNANDEZ ACAGNP-BC

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	363LA2200X	Adult Health Nurse Practitioner	5023783	NC

General Provider Information

NPI Number	:	1669979472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSA FERNANDEZ ACAGNP-BC

Provider Business Mailing Address
First Line	:	7105 SALTPETER ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-6802
Country	:	US
Telephone Number	:	609-218-7011
Fax Number	:

Provider Business Practice Location Address
First Line	:	7105 SALTPETER ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-6802
Country	:	US
Telephone Number	:	609-218-7011
Fax Number	:

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

Provider Enumeration Date	:	04/09/2018
Last Update Date	:	01/28/2026

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