MEDICARE: MAIRELIS DE LA CRUZ HERNANDEZ

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	11004732	FL
2	363LP2300X	Primary Care Nurse Practitioner	11004732	FL
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11004732	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	:	1588295919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAIRELIS DE LA CRUZ HERNANDEZ

Provider Business Mailing Address
First Line	:	971 CHIQUITA BLVD S
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-2143
Country	:	US
Telephone Number	:	786-351-4243
Fax Number	:

Provider Business Practice Location Address
First Line	:	971 CHIQUITA BLVD S
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-2143
Country	:	US
Telephone Number	:	786-351-4243
Fax Number	:

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

Provider Enumeration Date	:	02/04/2020
Last Update Date	:	02/24/2025

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Directions to “ MAIRELIS DE LA CRUZ HERNANDEZ ” Practice Location

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