Provider Demographics
NPI:1336748904
Name:FERNANDEZ, JUAN CALOS SR (ARNP-FMP-BC, MSN)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:CALOS
Last Name:FERNANDEZ
Suffix:SR
Gender:M
Credentials:ARNP-FMP-BC, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8862 SW 209TH TER
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-3418
Mailing Address - Country:US
Mailing Address - Phone:786-553-7561
Mailing Address - Fax:
Practice Address - Street 1:9700 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2311
Practice Address - Country:US
Practice Address - Phone:855-226-6633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-23
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11004273363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily