Provider Demographics
NPI:1245821586
Name:FERNANDEZ-OSBORNE, AMY JANINA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:JANINA
Last Name:FERNANDEZ-OSBORNE
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:JANINA
Other - Last Name:FERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10650 PARK RD STE 220
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8542
Mailing Address - Country:US
Mailing Address - Phone:704-667-3840
Mailing Address - Fax:
Practice Address - Street 1:10650 PARK RD STE 220
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8542
Practice Address - Country:US
Practice Address - Phone:704-667-3840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-29
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4226363A00000X
390200000X
NC001012194363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program