Provider Demographics
NPI:1982932778
Name:ROSS, FERNANDER JR (CNA)
Entity Type:Individual
Prefix:MR
First Name:FERNANDER
Middle Name:
Last Name:ROSS
Suffix:JR
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:548 MYRTLE PL
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-3330
Mailing Address - Country:US
Mailing Address - Phone:386-453-9651
Mailing Address - Fax:
Practice Address - Street 1:548 MYRTLE PL
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-3330
Practice Address - Country:US
Practice Address - Phone:386-453-9651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA175018376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide