Provider Demographics
NPI:1710068911
Name:FERNANDEZ, ERIN ELIZABETH (MS, ATC, LAT)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:ELIZABETH
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 BURKE RD APT 1214
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-3480
Mailing Address - Country:US
Mailing Address - Phone:713-477-3601
Mailing Address - Fax:
Practice Address - Street 1:16811 KINGS CHAPEL CT
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-2339
Practice Address - Country:US
Practice Address - Phone:832-724-4613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN080402485174400000X
TXAT33122083S0010X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080402485OtherNATA CERTIFICATION
TXAT3312OtherATHLETIC TRAINING