MEDICARE: SHUJEN T FERNANDEZ ARNP-C, CCRN

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	363L00000X	Nurse Practitioner	ARNP9167756	FL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN9167756	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OB747	OTHER	FL	PTAN
2	2018014428	OTHER	FL	ANCC
3	F0914948	OTHER	FL	AMERICAN ACADEMY OF NURSE PRACTITIONERS
4	IA275X	OTHER	FL	PTAN NO
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912304759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHUJEN T FERNANDEZ ARNP-C, CCRN

Provider Business Mailing Address
First Line	:	2316 HILLCREST ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-4900
Country	:	US
Telephone Number	:	407-228-2804
Fax Number	:	407-228-2806

Provider Business Practice Location Address
First Line	:	10920 MOSS PARK RD STE 200
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32832-6087
Country	:	US
Telephone Number	:	407-846-0533
Fax Number	:	407-518-1730

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

Provider Enumeration Date	:	11/21/2014
Last Update Date	:	10/19/2021

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