Provider Demographics
NPI:1679310866
Name:PALACIOS, FERNANDO JR (NP)
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:
Last Name:PALACIOS
Suffix:JR
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 SHORE PKWY APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-6231
Mailing Address - Country:US
Mailing Address - Phone:718-924-4596
Mailing Address - Fax:
Practice Address - Street 1:1407 SHORE PKWY APT 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-6231
Practice Address - Country:US
Practice Address - Phone:718-924-4596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-13
Last Update Date:2024-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY354757363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily