MEDICARE: NICOLE 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	106S00000X	Behavior Technician		FL

General Provider Information

NPI Number	:	1588509970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE HERNANDEZ

Provider Business Mailing Address
First Line	:	6406 N CAMERON AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-4813
Country	:	US
Telephone Number	:	813-375-1941
Fax Number	:

Provider Business Practice Location Address
First Line	:	6406 N CAMERON AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-4813
Country	:	US
Telephone Number	:	813-375-1941
Fax Number	:

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

Provider Enumeration Date	:	04/21/2026
Last Update Date	:	04/21/2026

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Directions to “ NICOLE HERNANDEZ ” Practice Location

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