Organization Active NPI

Dr Anthony a Fernandez MD PA

  • Medical Specialty Clinic/Center
  • Tampa, FL
National Provider Identifier
1174828313
Registry record updated Jan 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
License
ME0008628 Issued in FL
Legal business name
DR ANTHONY A FERNANDEZ MD PA
Practice address
4600 N Habana Ave
Ste 16
Tampa, FL 33614-7112
Phone
(813) 876-0502
Fax
(813) 872-6503
NPI assigned
Jan 19, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Anthony Alvaro Fernandez, M.D.
Title
President
Phone
(813) 876-0502

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X ME0008628 FL Primary

Addresses

Primary practice location

4600 N Habana Ave
Ste 16
Tampa, FL 33614-7112

Mailing address

4600 N Habana Ave
Ste 16
Tampa, FL 33614-7112
Phone (813) 876-0502

Other identifiers 1

IdentifierTypeStateIssuer
043154100MedicaidFL

National Provider Directory

National Provider Directory

Locations

4600 N Habana Ave
Ste 16
Tampa, FL 33614
Phone (813) 876-0502

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1295395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295395200000",
    "number": "1174828313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4600 N HABANA AVE",
            "address_2": "STE 16",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336147112",
            "telephone_number": "813-876-0502",
            "fax_number": "813-872-6503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 N HABANA AVE",
            "address_2": "STE 16",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336147112",
            "telephone_number": "813-876-0502",
            "fax_number": "813-872-6503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR ANTHONY A FERNANDEZ MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-19",
        "last_updated": "2011-01-19",
        "status": "A",
        "authorized_official_last_name": "FERNANDEZ",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "ALVARO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-876-0502",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "FL",
            "license": "ME0008628",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "043154100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.