Provider Demographics
NPI:1124229497
Name:FERNANDEZ, VANIA ENID (MD)
Entity Type:Individual
Prefix:DR
First Name:VANIA
Middle Name:ENID
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17577
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32245-7577
Mailing Address - Country:US
Mailing Address - Phone:904-399-1623
Mailing Address - Fax:
Practice Address - Street 1:3702 WASHINGTON ST STE 101
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8283
Practice Address - Country:US
Practice Address - Phone:954-272-2225
Practice Address - Fax:954-272-0554
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98334207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine