Provider Demographics
NPI:1134809288
Name:FERNANDEZ-CALIENES, ISMEL (PMHNP)
Entity type:Individual
Prefix:
First Name:ISMEL
Middle Name:
Last Name:FERNANDEZ-CALIENES
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12891 SW 62ND LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-5450
Mailing Address - Country:US
Mailing Address - Phone:786-370-3039
Mailing Address - Fax:
Practice Address - Street 1:8532 SW 8TH ST STE 290
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4054
Practice Address - Country:US
Practice Address - Phone:786-927-8048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11027919363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL121994300Medicaid