Provider Demographics
NPI:1558179580
Name:FERNANDEZ, LAUREANO JR (RN)
Entity type:Individual
Prefix:
First Name:LAUREANO
Middle Name:
Last Name:FERNANDEZ
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 MAJORCA PL APT 2042
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5543
Mailing Address - Country:US
Mailing Address - Phone:305-305-0263
Mailing Address - Fax:
Practice Address - Street 1:7600 MAJORCA PL APT 2042
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5543
Practice Address - Country:US
Practice Address - Phone:305-305-0263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9576006163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy