MEDICARE: JERRY HERNANDEZ SR. ARNP, FNP-ACAGNP

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	363L00000X	Nurse Practitioner	ARNP9335689	FL

General Provider Information

NPI Number	:	1396283578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRY HERNANDEZ SR. ARNP, FNP-ACAGNP

Provider Business Mailing Address
First Line	:	130 E MARION AVE UNIT 511323
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33951-3662
Country	:	US
Telephone Number	:	941-876-8486
Fax Number	:

Provider Business Practice Location Address
First Line	:	3691 TAMIAMI TRL
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-7228
Country	:	US
Telephone Number	:	941-876-8486
Fax Number	:

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

Provider Enumeration Date	:	02/07/2017
Last Update Date	:	09/09/2021

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