Provider Demographics
NPI:1952478323
Name:SMITH-FERNANDEZ, HEATHER LYN (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:LYN
Last Name:SMITH-FERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:LYN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2350 VANDERBILT BEACH RD
Mailing Address - Street 2:SUITE 302B
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-2760
Mailing Address - Country:US
Mailing Address - Phone:239-513-0055
Mailing Address - Fax:239-596-6544
Practice Address - Street 1:2350 VANDERBILT BEACH RD
Practice Address - Street 2:SUITE 302B
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-2760
Practice Address - Country:US
Practice Address - Phone:239-513-0055
Practice Address - Fax:239-596-6544
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98168207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278102600Medicaid
FLAD798XOtherMEDICARE PTAN