Provider Demographics
NPI:1255228078
Name:FERNANDEZ, VIRGINIA LYNN (RN)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:LYNN
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 COYOTE PASS CT
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-8434
Mailing Address - Country:US
Mailing Address - Phone:914-441-6430
Mailing Address - Fax:
Practice Address - Street 1:2414 E SHAWNEE RD
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-1530
Practice Address - Country:US
Practice Address - Phone:918-577-3699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0062846163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse