Provider Demographics
NPI:1932249455
Name:FERNANDEZ, CARLOS HUMBERTO (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:HUMBERTO
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2052
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444
Mailing Address - Country:US
Mailing Address - Phone:850-248-7925
Mailing Address - Fax:850-248-7928
Practice Address - Street 1:1606 TENNESSEE AVE.
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444
Practice Address - Country:US
Practice Address - Phone:850-248-7925
Practice Address - Fax:850-248-7928
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 3314363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical