Provider Demographics
NPI:1295539971
Name:FERNANDEZ PINO, NURY
Entity type:Individual
Prefix:
First Name:NURY
Middle Name:
Last Name:FERNANDEZ PINO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 FOGGY RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-6717
Mailing Address - Country:US
Mailing Address - Phone:786-859-0209
Mailing Address - Fax:
Practice Address - Street 1:1426 FOGGY RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-6717
Practice Address - Country:US
Practice Address - Phone:786-859-0209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF621-479-18-700-0106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician