Healthcare Provider Details

I. General information

NPI: 1396556486
Provider Name (Legal Business Name): ERNESTO HERNANDEZ KREPISHOV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 E ALTAMONTE DR STE 315
ALTAMONTE SPRINGS FL
32701-5103
US

IV. Provider business mailing address

661 E ALTAMONTE DR STE 315 STE 315
ALTAMONTE SPRINGS FL
32701-5103
US

V. Phone/Fax

Practice location:
  • Phone: 407-339-3002
  • Fax: 321-397-5085
Mailing address:
  • Phone: 407-339-3002
  • Fax: 321-397-5085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11037157
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: