Provider Demographics
NPI:1629249438
Name:FERNANDES, ROBIN IRENE (NP)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:IRENE
Last Name:FERNANDES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:ROBIN
Other - Middle Name:IRENE
Other - Last Name:DAVID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2001 DWIGHT WAY
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2608
Mailing Address - Country:US
Mailing Address - Phone:510-204-1591
Mailing Address - Fax:510-204-7822
Practice Address - Street 1:1480 64TH ST STE 100
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-2038
Practice Address - Country:US
Practice Address - Phone:510-629-6682
Practice Address - Fax:510-830-3316
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17980363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA650499OtherRN LICENSE NUMBER