MEDICARE: MR. EDWARD MANUEL HERNANDEZ APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	11014757	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023786670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDWARD MANUEL HERNANDEZ APRN

Provider Business Mailing Address
First Line	:	3143 NE 163RD ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33160-4463
Country	:	US
Telephone Number	:	305-343-1365
Fax Number	:

Provider Business Practice Location Address
First Line	:	3143 NE 163RD ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33160-4463
Country	:	US
Telephone Number	:	305-343-1365
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2021
Last Update Date	:	02/04/2023

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