Individual
DR. JUAN CARLOS FERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11031 US HIGHWAY 19 STE 102, PORT RICHEY, FL 34668-2213
(813) 488-4801
Mailing address
11031 US HIGHWAY 19 STE 102, PORT RICHEY, FL 34668-2213
(813) 488-4801
(000) 000-0000
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
16640
PR
208D00000X
General Practice Physician
4301119074
MI
208D00000X
General Practice Physician
ACN258
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16640
MEDICAL LICENSE
PR
01
—
4301119074
OTHER
MI
01
—
ACN258
ACN MEDICAL LICENSE
FL
Enumeration date
04/10/2007
Last updated
02/02/2026
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