MEDICARE: ANTHONY ENRIQUE HERNANDEZ PA-C

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	363A00000X	Physician Assistant	PA9116684	FL

General Provider Information

NPI Number	:	1033824388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY ENRIQUE HERNANDEZ PA-C

Provider Business Mailing Address
First Line	:	692 E 19TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-4132
Country	:	US
Telephone Number	:	786-718-6992
Fax Number	:

Provider Business Practice Location Address
First Line	:	2040 WASHINGTON ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-6930
Country	:	US
Telephone Number	:	754-348-5001
Fax Number	:	754-799-1272

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

Provider Enumeration Date	:	01/20/2023
Last Update Date	:	03/19/2023

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