Provider Demographics
NPI:1902255995
Name:FERNANDEZ, RACEL LAMORIN (APN)
Entity type:Individual
Prefix:MRS
First Name:RACEL
Middle Name:LAMORIN
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 KRISTINE AVE
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-7810
Mailing Address - Country:US
Mailing Address - Phone:609-290-9459
Mailing Address - Fax:
Practice Address - Street 1:108 KRISTINE AVE
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-7810
Practice Address - Country:US
Practice Address - Phone:609-290-9459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00626000363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner