Provider Demographics
NPI:1578176814
Name:FERNANDES, TATIANA B (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TATIANA
Middle Name:B
Last Name:FERNANDES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6370 BAYSHORE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33917-3137
Mailing Address - Country:US
Mailing Address - Phone:239-656-1424
Mailing Address - Fax:
Practice Address - Street 1:6370 BAYSHORE RD
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33917-3137
Practice Address - Country:US
Practice Address - Phone:239-656-1424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS60340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist