Provider Demographics
NPI:1790308922
Name:FERNANDEZ SANCHEZ, SURELY (APRN)
Entity type:Individual
Prefix:
First Name:SURELY
Middle Name:
Last Name:FERNANDEZ SANCHEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 W OAKLAND PARK BLVD STE 100-101
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-7260
Mailing Address - Country:US
Mailing Address - Phone:954-408-2100
Mailing Address - Fax:
Practice Address - Street 1:4850 W OAKLAND PARK BLVD STE 100-101
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-7260
Practice Address - Country:US
Practice Address - Phone:954-408-2100
Practice Address - Fax:561-328-8632
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-21
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11006176363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily