Provider Demographics
NPI:1093378440
Name:FERNANDEZ, JACINTO
Entity type:Individual
Prefix:
First Name:JACINTO
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6888 SW 90TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-9238
Mailing Address - Country:US
Mailing Address - Phone:404-273-1763
Mailing Address - Fax:
Practice Address - Street 1:6888 SW 90TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-9238
Practice Address - Country:US
Practice Address - Phone:404-273-1763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-20
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME146990207P00000X, 209800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No209800000XAllopathic & Osteopathic PhysiciansLegal Medicine