Provider Demographics
NPI:1790391811
Name:FERNANDEZ, ASHLEY ESMERALDA
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ESMERALDA
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 DEBEVOISE AVE
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:NY
Mailing Address - Zip Code:11575-1712
Mailing Address - Country:US
Mailing Address - Phone:516-417-6509
Mailing Address - Fax:
Practice Address - Street 1:82 DEBEVOISE AVE
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:NY
Practice Address - Zip Code:11575-1712
Practice Address - Country:US
Practice Address - Phone:516-417-6509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33710501164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse