Provider Demographics
NPI:1093492209
Name:FERNANDEZ, JUAN CARLOS (APRN)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:CARLOS
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 W 39TH PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4340
Mailing Address - Country:US
Mailing Address - Phone:305-322-8143
Mailing Address - Fax:
Practice Address - Street 1:1751 BONAVENTURE BLVD # WESTON
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-4039
Practice Address - Country:US
Practice Address - Phone:888-689-8648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11028199363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care