Provider Demographics
NPI:1447095443
Name:AVILA FERNANDEZ, NELSA
Entity type:Individual
Prefix:
First Name:NELSA
Middle Name:
Last Name:AVILA FERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9302 NW 120TH ST APT 25
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4185
Mailing Address - Country:US
Mailing Address - Phone:786-817-7737
Mailing Address - Fax:
Practice Address - Street 1:9302 NW 120TH ST APT 25
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-4185
Practice Address - Country:US
Practice Address - Phone:786-817-7737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide