Provider Demographics
NPI:1548816069
Name:FERNANDEZ, HEIDY CHANNEL (PHYSICAL ASSISTANT)
Entity type:Individual
Prefix:
First Name:HEIDY
Middle Name:CHANNEL
Last Name:FERNANDEZ
Suffix:
Gender:
Credentials:PHYSICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4611 OKEECHOBEE BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-4637
Mailing Address - Country:US
Mailing Address - Phone:561-408-9444
Mailing Address - Fax:561-689-7500
Practice Address - Street 1:4611 OKEECHOBEE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:WEST PALM BCH
Practice Address - State:FL
Practice Address - Zip Code:33417-4637
Practice Address - Country:US
Practice Address - Phone:561-408-9444
Practice Address - Fax:561-689-7500
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FL9113973363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program