Provider Demographics
NPI:1972970481
Name:DIANNE M FERNANDEZ DC PA
Entity type:Organization
Organization Name:DIANNE M FERNANDEZ DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-280-2323
Mailing Address - Street 1:6166 SEMINOLE BLVD
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-6835
Mailing Address - Country:US
Mailing Address - Phone:727-280-2323
Mailing Address - Fax:727-201-4988
Practice Address - Street 1:6166 SEMINOLE BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-6835
Practice Address - Country:US
Practice Address - Phone:727-280-2323
Practice Address - Fax:727-201-4988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5777111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty