1629472923 NPI number — CINDY VANESSA FERNANDEZ ARNP

Table of content: CINDY VANESSA FERNANDEZ ARNP (NPI 1629472923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629472923 NPI number — CINDY VANESSA FERNANDEZ ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERNANDEZ
Provider First Name:
CINDY
Provider Middle Name:
VANESSA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629472923
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5056 NW 125TH AVE
Provider Second Line Business Mailing Address:
NONE
Provider Business Mailing Address City Name:
CORAL SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33076-3438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
754-422-1393
Provider Business Mailing Address Fax Number:
954-796-6480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5056 NW 125TH AVE
Provider Second Line Business Practice Location Address:
NONE
Provider Business Practice Location Address City Name:
CORAL SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33076-3438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
754-422-1393
Provider Business Practice Location Address Fax Number:
954-796-6480
Provider Enumeration Date:
10/15/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  ARNP9366953 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 017174500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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