Provider Demographics
NPI:1891245338
Name:FERNANDEZ, JOHANS (SA-C)
Entity Type:Individual
Prefix:
First Name:JOHANS
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:SA-C
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 811
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-0811
Mailing Address - Country:US
Mailing Address - Phone:407-755-9495
Mailing Address - Fax:407-395-2587
Practice Address - Street 1:1625 S KIRKMAN RD APT 9204
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-2579
Practice Address - Country:US
Practice Address - Phone:407-755-9495
Practice Address - Fax:407-250-8945
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15-763246ZC0007X, 246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant