MEDICARE: TAMARA HERNANDEZ RODRIGUEZ 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	363LP2300X	Primary Care Nurse Practitioner	11044002	FL

General Provider Information

NPI Number	:	1740142264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA HERNANDEZ RODRIGUEZ APRN

Provider Business Mailing Address
First Line	:	580 NW UNIVERSITY BLVD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34986-2221
Country	:	US
Telephone Number	:	954-697-9292
Fax Number	:

Provider Business Practice Location Address
First Line	:	584 NW UNIVERSITY BLVD STE 200
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34986-2266
Country	:	US
Telephone Number	:	772-251-0022
Fax Number	:	772-251-0021

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

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	03/26/2026

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