Provider Demographics
NPI:1912304759
Name:FERNANDEZ, SHUJEN T (ARNP-C, CCRN)
Entity type:Individual
Prefix:
First Name:SHUJEN
Middle Name:T
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:ARNP-C, CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 HILLCREST ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4900
Mailing Address - Country:US
Mailing Address - Phone:407-228-2804
Mailing Address - Fax:407-228-2806
Practice Address - Street 1:10920 MOSS PARK RD STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-6087
Practice Address - Country:US
Practice Address - Phone:407-846-0533
Practice Address - Fax:407-518-1730
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9167756363L00000X
FLAPRN9167756363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOB747OtherPTAN
FL2018014428OtherANCC
FLF0914948OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS
FLIA275XOtherPTAN NO