Provider Demographics
NPI:1598914871
Name:FERNANDEZ, CAROLINA (PA)
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CAROLINA
Other - Middle Name:
Other - Last Name:ALVAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:151 SOUTHHALL LN
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7176
Mailing Address - Country:US
Mailing Address - Phone:407-875-2080
Mailing Address - Fax:407-650-3455
Practice Address - Street 1:12600 PEMBROKE RD
Practice Address - Street 2:STE 312
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-2544
Practice Address - Country:US
Practice Address - Phone:954-431-7681
Practice Address - Fax:954-431-7682
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104757363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAN045AMedicare PIN
FLAN045ZMedicare PIN