Provider Demographics
NPI:1700829769
Name:FERNANDEZ, JOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:509 S ARMENIA AVE
Practice Address - Street 2:STE 200
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3395
Practice Address - Country:US
Practice Address - Phone:813-353-1515
Practice Address - Fax:813-353-0865
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76424207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262402800Medicaid
H40016Medicare UPIN
FL26002XMedicare PIN
FL262402800Medicaid