Provider Demographics
NPI:1164488128
Name:NORONA, FERNANDO (MD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:
Last Name:NORONA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 NW 13TH ST
Mailing Address - Street 2:SUITE2B
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2359
Mailing Address - Country:US
Mailing Address - Phone:561-394-0005
Mailing Address - Fax:561-393-0048
Practice Address - Street 1:951 NW 13TH ST
Practice Address - Street 2:SUITE2B
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2359
Practice Address - Country:US
Practice Address - Phone:561-394-0005
Practice Address - Fax:561-393-0048
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74877174400000X
WI1011032084N0400X
OH35.1348222084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL49479ZOtherBLUE SHIELD PROVIDER
FL650963053OtherTAX ID
FLK4132OtherPTAN
FL032627OtherNHP
FLME74877OtherMEDICAL LICENSE
FL49479ZOtherBLUE SHIELD PROVIDER
FLG44347Medicare UPIN
FL032627OtherNHP