Provider Demographics
NPI:1316385222
Name:FERNANDES, DEANNA CELESTE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:CELESTE
Last Name:FERNANDES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 SW 16TH CT
Mailing Address - Street 2:UNIT K-22
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-1516
Mailing Address - Country:US
Mailing Address - Phone:352-222-5821
Mailing Address - Fax:
Practice Address - Street 1:1700 SW 16TH CT
Practice Address - Street 2:UNIT K-22
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1516
Practice Address - Country:US
Practice Address - Phone:352-222-5821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS476661835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS47666OtherPHARMACIST LICENSE