Individual
ANDRE LAGE FERNANDES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12901 BRUCE B DOWNS BLVD, TAMPA, FL 33612-4742
(813) 974-5699
Mailing address
17110 CARRINGTON PARK DR APT 824, TAMPA, FL 33647-2632
(407) 437-6637
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
PSI33186
FL
Other
Enumeration date
09/21/2017
Last updated
09/21/2017
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