Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 26NN09093100 | NJ |
Y | 363LA2100X | Nurse Practitioner - Acute Care | 26NN09093100 | NJ |
NPI | 1013903954 |
---|---|
Provider Name | Mrs. Carolyn Ann Fernandez |
First Address | Toms River, NJ 08755-8023 |
Second Address | Toms River, NJ 08755 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2005 |
Last Update Date | 06/08/2018 |