Provider Information for 1780207696
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AMANDA FERNANDEZ
Sex: Female
NPI: 1780207696
Last Updated: 2025-01-30
Certification Date: 2025-01-30
Certification Date: 2025-01-30
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1780207696 | ||||||||
| Enumeration Date | 2020-05-26 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 6421 N FLORIDA AVE STE D-1605 TAMPA, FL 33604-6007 United States Phone: 904-717-1618 | Fax: | ||||||||
| Primary Practice Address | 6421 N FLORIDA AVE STE D-1605 TAMPA, FL 33604-6007 United States Phone: 813-474-8567 | Fax: | ||||||||
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