Provider Demographics
NPI:1376159525
Name:FERNANDEZ, JONATAN DAVID (RN)
Entity Type:Individual
Prefix:
First Name:JONATAN
Middle Name:DAVID
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:384 WHIPPLE ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-2847
Mailing Address - Country:US
Mailing Address - Phone:631-645-7991
Mailing Address - Fax:
Practice Address - Street 1:384 WHIPPLE ST
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-2847
Practice Address - Country:US
Practice Address - Phone:631-645-7991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY787701163W00000X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163W00000XNursing Service ProvidersRegistered Nurse