Provider Demographics
NPI:1255110128
Name:FERNANDEZ, NILSA (CBCS)
Entity type:Individual
Prefix:
First Name:NILSA
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:CBCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6251 REVELRY CT
Mailing Address - Street 2:
Mailing Address - City:AVE MARIA
Mailing Address - State:FL
Mailing Address - Zip Code:34142-9726
Mailing Address - Country:US
Mailing Address - Phone:786-422-2415
Mailing Address - Fax:786-373-3043
Practice Address - Street 1:6251 REVELRY CT
Practice Address - Street 2:
Practice Address - City:AVE MARIA
Practice Address - State:FL
Practice Address - Zip Code:34142-9726
Practice Address - Country:US
Practice Address - Phone:786-422-2415
Practice Address - Fax:786-373-3043
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5J5X3G6OtherNATIONAL HEALTHCARE ASSOCIATION