MEDICARE: GISELLE FERNANDEZ APRN, FNP-C

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	363LF0000X	Family Nurse Practitioner	11005255	FL

General Provider Information

NPI Number	:	1982238416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GISELLE FERNANDEZ APRN, FNP-C

Provider Business Mailing Address
First Line	:	5862 SW 147TH PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33193-2449
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5862 SW 147TH PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33193-2449
Country	:	US
Telephone Number	:	305-607-9041
Fax Number	:

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

Provider Enumeration Date	:	02/24/2020
Last Update Date	:	02/24/2020

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