Andre Lage Fernandes

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

PSI33186 Issued in FL

Practice address

12901 Bruce B Downs Blvd
Tampa, FL 33612-4742

Phone

(813) 974-5699

NPI assigned

Sep 21, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1505952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1505952000000",
    "number": "1669981726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17110 CARRINGTON PARK DR APT 824",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336472632",
            "telephone_number": "407-437-6637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12901 BRUCE B DOWNS BLVD",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336124742",
            "telephone_number": "813-974-5699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERNANDES",
        "first_name": "ANDRE",
        "middle_name": "LAGE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-09-21",
        "last_updated": "2017-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "FL",
            "license": "PSI33186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nina H. Ferguson, M.D.
• Virginia Nicole Ferguson, DPT
• Rose Virginia Ferlita, R.PH.
• Theresa M. Ferlita, M.S.
• Karen Fermin
• Angelo Miguel Fernandes, MD
• Lyndsey Margaret Fernandes
• Molly Fernandes
• Paijah Fernandes
• Odalis Fernandez Batista, RBT

• Student in an Organized Health Care Education/Training Program in Tampa, FL
• Providers in Tampa, FL by specialty
• Student in an Organized Health Care Education/Training Program in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2017; 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.