Provider Demographics
NPI:1821291451
Name:JENARO FERNANDEZ MD PA
Entity Type:Organization
Organization Name:JENARO FERNANDEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENARO
Authorized Official - Middle Name:FELIX
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-804-9551
Mailing Address - Street 1:1401 LANGHAM TER
Mailing Address - Street 2:
Mailing Address - City:HEATHROW
Mailing Address - State:FL
Mailing Address - Zip Code:32746-1966
Mailing Address - Country:US
Mailing Address - Phone:407-804-9551
Mailing Address - Fax:
Practice Address - Street 1:1401 LANGHAM TER
Practice Address - Street 2:
Practice Address - City:HEATHROW
Practice Address - State:FL
Practice Address - Zip Code:32746-1966
Practice Address - Country:US
Practice Address - Phone:407-804-9551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00531912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0053191OtherMEDICAL LICENSE
FL05990Medicare ID - Type UnspecifiedPROVIDER #
FLME0053191OtherMEDICAL LICENSE