Provider Demographics
NPI:1194285486
Name:PONCE, FERNANDA SAMIRA (MD)
Entity type:Individual
Prefix:DR
First Name:FERNANDA
Middle Name:SAMIRA
Last Name:PONCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8750 SW 144TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7229
Mailing Address - Country:US
Mailing Address - Phone:786-596-3840
Mailing Address - Fax:
Practice Address - Street 1:8750 SW 144TH ST STE 100
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33176-7229
Practice Address - Country:US
Practice Address - Phone:786-596-3840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2023-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT69878207R00000X
FLME156325207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine