Provider Demographics
NPI:1124533138
Name:FERNANDEZ, CAITLIN J (CRNP)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:J
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:J
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:114 UNIVERSITY AVE
Mailing Address - Street 2:ATTN CREDENTIALING
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14605-6626
Mailing Address - Country:US
Mailing Address - Phone:585-546-2771
Mailing Address - Fax:315-222-7435
Practice Address - Street 1:114 UNIVERSITY AVE
Practice Address - Street 2:ATTN CREDENTIALING
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14605-6626
Practice Address - Country:US
Practice Address - Phone:585-546-2771
Practice Address - Fax:315-222-7435
Is Sole Proprietor?:No
Enumeration Date:2017-12-13
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018683363LF0000X
NYF348628-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06742736Medicaid