| Entity Name: | LUIS F FERNANDEZ, MD PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 09 Jul 2018 (7 years ago) |
| Document Number: | P18000059732 |
| FEI/EIN Number | 812745175 |
| Address: | 2400 HARBOR BLVD, SUITE 5, PORT CHARLOTTE, FL, 33952, US |
| Mail Address: | 2400 HARBOR BLVD, SUITE 5, PORT CHARLOTTE, FL, 33952, US |
| ZIP code: | 33952 |
| County: | Charlotte |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1861150773 | 2021-12-08 | 2022-06-07 | PO BOX 495477, PORT CHARLOTTE, FL, 339495477, US | 2400 HARBOR BLVD STE 5, PORT CHARLOTTE, FL, 339525038, US | |||||||||||||||||||||||||||||
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| Phone | +1 941-766-1901 |
| Fax | 9417647039 |
| Phone | +1 941-764-7999 |
Authorized person
| Name | DR. LUIS F FERNANDEZ |
| Role | OWNER |
| Phone | 9416613434 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE |
| Number | 10091A |
| State | FL |
| Issuer | STATE LICENSE |
| Number | ME0056435 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FERNANDEZ ANNA | Agent | 2400 HARBOR BLVD, PORT CHARLOTTE, FL, 33952 |
| Name | Role | Address |
|---|---|---|
| FERNANDEZ LUIS | President | 2400 HARBOR BLVD, PORT CHARLOTTE, FL, 33952 |
| Name | Role | Address |
|---|---|---|
| FERNANDEZ ANNA | Vice President | 2400 HARBOR BLVD, PORT CHARLOTTE, FL, 33952 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-06 |
| ANNUAL REPORT | 2023-01-31 |
| ANNUAL REPORT | 2022-02-07 |
| ANNUAL REPORT | 2021-02-18 |
| ANNUAL REPORT | 2020-02-13 |
| ANNUAL REPORT | 2019-05-09 |
| Domestic Profit | 2018-07-09 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
