Provider Demographics
NPI:1598057499
Name:FERNANDES, CHRISTINE (RPA-C)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:
Last Name:FERNANDES
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 72
Mailing Address - Street 2:
Mailing Address - City:CARLE PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11514-0072
Mailing Address - Country:US
Mailing Address - Phone:516-395-0207
Mailing Address - Fax:
Practice Address - Street 1:24818 UNION TPKE
Practice Address - Street 2:
Practice Address - City:BELLEROSE
Practice Address - State:NY
Practice Address - Zip Code:11426-1837
Practice Address - Country:US
Practice Address - Phone:718-347-7621
Practice Address - Fax:718-347-4564
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014242363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant