Provider Demographics
NPI:1033283643
Name:FERNANDEZ, ANA MARIA (RN, MSN, CPNP)
Entity Type:Individual
Prefix:
First Name:ANA MARIA
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:RN, MSN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 TRENT DR. SUITE 0110
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710
Mailing Address - Country:US
Mailing Address - Phone:919-668-3111
Mailing Address - Fax:919-660-0591
Practice Address - Street 1:200 TRENT DR STE 110
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-2319
Practice Address - Country:US
Practice Address - Phone:919-668-3111
Practice Address - Fax:919-660-0591
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5000501363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL86361543135001Medicaid