Provider Demographics
NPI:1538648647
Name:FERNANDEZ, AMARILYS (ARNP)
Entity Type:Individual
Prefix:
First Name:AMARILYS
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10292 SW 158TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-5409
Mailing Address - Country:US
Mailing Address - Phone:786-294-1384
Mailing Address - Fax:
Practice Address - Street 1:10292 SW 158TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-5409
Practice Address - Country:US
Practice Address - Phone:786-294-1384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2024-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21343225200000X
FL11031664363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily