Provider Demographics
NPI:1346592599
Name:FERNANDEZ FONSECA, JENIALEEN (RN)
Entity Type:Individual
Prefix:MS
First Name:JENIALEEN
Middle Name:
Last Name:FERNANDEZ FONSECA
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:HC 2 BOX 29424
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-9475
Mailing Address - Country:US
Mailing Address - Phone:939-630-9243
Mailing Address - Fax:
Practice Address - Street 1:URB. LOS ANGELES CALLE ACUARIO 101
Practice Address - Street 2:ISLA VERDE
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00919-0919
Practice Address - Country:US
Practice Address - Phone:939-630-9243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15554163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse