Provider Demographics
NPI:1336748904
Name:FERNANDEZ, JUAN CALOS SR (ARNP-FMP-BC, MSN)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:CALOS
Last Name:FERNANDEZ
Suffix:SR
Gender:M
Credentials:ARNP-FMP-BC, MSN
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Mailing Address - Street 1:860 NW 42ND AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-4172
Mailing Address - Country:US
Mailing Address - Phone:305-504-7885
Mailing Address - Fax:
Practice Address - Street 1:16201 SW 95TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-3459
Practice Address - Country:US
Practice Address - Phone:305-946-1605
Practice Address - Fax:888-720-2691
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-23
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL11004273363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily