Provider Demographics
NPI:1750911509
Name:FERNANDEZ, SANDRA MARIA (ARNP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:MARIA
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 SW 63RD CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-3141
Mailing Address - Country:US
Mailing Address - Phone:786-451-0111
Mailing Address - Fax:
Practice Address - Street 1:19000 SW 377TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33034-6405
Practice Address - Country:US
Practice Address - Phone:786-349-6239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-21
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11005330207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine