Provider Demographics
NPI:1386451359
Name:FERNANDEZ HERNANDEZ, IVANET
Entity type:Individual
Prefix:
First Name:IVANET
Middle Name:
Last Name:FERNANDEZ HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 CULTURAL PARK BLVD S
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-1213
Mailing Address - Country:US
Mailing Address - Phone:239-355-4196
Mailing Address - Fax:
Practice Address - Street 1:541 CULTURAL PARK BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-1213
Practice Address - Country:US
Practice Address - Phone:239-355-4196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT24327429106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician