Provider Demographics
NPI:1629565619
Name:FERNANDEZ, VERONICA (PA)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2542 CENTRAL PALM DR STE 207
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-6766
Mailing Address - Country:US
Mailing Address - Phone:956-352-1344
Mailing Address - Fax:956-352-1343
Practice Address - Street 1:2542 CENTRAL PALM DR STE 207
Practice Address - Street 2:
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-6766
Practice Address - Country:US
Practice Address - Phone:956-352-1344
Practice Address - Fax:956-352-1343
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA11947363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical