MEDICARE: KRISTIN P. FERNANDEZ D.O.

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	207VG0400X	Gynecology Physician	OS7697	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982665279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN P. FERNANDEZ D.O.

Provider Business Mailing Address
First Line	:	PO BOX 748817
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-8817
Country	:	US
Telephone Number	:	813-286-0033
Fax Number	:	813-282-1806

Provider Business Practice Location Address
First Line	:	14534 OLD SAINT AUGUSTINE RD STE 3430
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-2645
Country	:	US
Telephone Number	:	904-268-5300
Fax Number	:	904-268-5040

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

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	06/23/2023

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Directions to “ KRISTIN P. FERNANDEZ D.O.” Practice Location

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