Provider Demographics
NPI:1497849962
Name:FERNANDEZ, ANN MARY (DO)
Entity Type:Individual
Prefix:DR
First Name:ANN MARY
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 NE 30 TERR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-7614
Mailing Address - Country:US
Mailing Address - Phone:305-246-1030
Mailing Address - Fax:305-246-2387
Practice Address - Street 1:925 NE 30TH TER
Practice Address - Street 2:SUITE 202
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7614
Practice Address - Country:US
Practice Address - Phone:305-246-1030
Practice Address - Fax:305-246-2387
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 0006734208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016889900Medicaid
FL016889900Medicaid
FL378552101Medicaid