Provider Demographics
NPI:1457021081
Name:FERNANDEZ FUENTES, MAYELIN (APRN)
Entity Type:Individual
Prefix:MS
First Name:MAYELIN
Middle Name:
Last Name:FERNANDEZ FUENTES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4759 LAKEVIEW DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-2005
Mailing Address - Country:US
Mailing Address - Phone:863-402-5600
Mailing Address - Fax:638-402-5602
Practice Address - Street 1:4759 LAKEVIEW DR STE 101
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-2005
Practice Address - Country:US
Practice Address - Phone:863-402-5600
Practice Address - Fax:863-402-5602
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11014694207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine