Individual provider Active NPI

Surely Fernandez Sanchez, APRN

  • Family Nurse Practitioner
  • Lauderdale Lakes, FL
National Provider Identifier
1790308922
Registry record updated Oct 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
11006176 Issued in FL
Practice address
4850 W Oakland Park Blvd Ste 100-101
Lauderdale Lakes, FL 33313-7260
Phone
(954) 408-2100
Fax
(561) 328-8632
NPI assigned
May 21, 2020
Last updated
Oct 16, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 11006176 FL Primary

Addresses

Primary practice location

4850 W Oakland Park Blvd Ste 100-101
Lauderdale Lakes, FL 33313-7260

Mailing address

4850 W Oakland Park Blvd Ste 100-101
Lauderdale Lakes, FL 33313-7260
Phone (954) 408-2100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240305004261 FL Practitioner - Nurse Practitioner 5698111284 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11006176FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pasteur & Wellmax Medical Centers LLC CurrentSince Oct 29, 2024 Accepting new patients
Pasteur & Wellmax Medical Centers LLC CurrentSince Oct 29, 2024 Accepting new patients
Clinica Las Mercedes, LLC Current Accepting new patients
Pasteur & Wellmax Medical Centers LLC Current Accepting new patients
Clinica Las Mercedes, LLC CurrentSince Oct 7, 2024 Accepting new patients
Clinica Las Mercedes, LLC CurrentSince Oct 7, 2024 Accepting new patients
Pasteur & Wellmax Medical Centers LLC CurrentSince Oct 20, 2024 Accepting new patients

Locations

1479 NW 27th Ave
Miami, FL 33125
Phone (305) 633-3776

1500 S Hiatus Rd
Pembroke Pines, FL 33025
Phone (954) 438-4000

450 SW 136th Ave
Pembroke Pines, FL 33027
Phone (954) 239-4818

6355 NW 36th St
Ste 1100
Virginia Gardens, FL 33166

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1590019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729036800000",
    "number": "1790308922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4850 W OAKLAND PARK BLVD STE 100-101",
            "city": "LAUDERDALE LAKES",
            "state": "FL",
            "postal_code": "333137260",
            "telephone_number": "954-408-2100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4850 W OAKLAND PARK BLVD STE 100-101",
            "city": "LAUDERDALE LAKES",
            "state": "FL",
            "postal_code": "333137260",
            "telephone_number": "954-408-2100",
            "fax_number": "561-328-8632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERNANDEZ SANCHEZ",
        "first_name": "SURELY",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-05-21",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11006176",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lauderdale Lakes, FL

Sources for this page

Verify at the official NPI Registry.