Provider Demographics
NPI:1831080696
Name:FERNANDEZ, ANNY LUZ (PA)
Entity type:Individual
Prefix:DR
First Name:ANNY
Middle Name:LUZ
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 W SPRING ST
Mailing Address - Street 2:
Mailing Address - City:DE LEON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32130-4251
Mailing Address - Country:US
Mailing Address - Phone:407-663-2738
Mailing Address - Fax:
Practice Address - Street 1:HC 3 BOX 11911
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-9288
Practice Address - Country:US
Practice Address - Phone:407-663-2738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2390363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant