Individual
MR. OSVALDO E FERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4532 W KNOLLWOOD ST, TAMPA, FL 33614-3636
(813) 298-5692
Mailing address
4532 W KNOLLWOOD ST, TAMPA, FL 33614-3636
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
149025
FL
Other
Enumeration date
09/01/2009
Last updated
09/01/2009
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