Healthcare Provider Details

I. General information

NPI: 1205659984
Provider Name (Legal Business Name): JESSICA MARIE HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2024
Last Update Date: 03/08/2026
Certification Date: 03/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 NW 24TH AVE
CAPE CORAL FL
33993-4941
US

IV. Provider business mailing address

1720 NW 24TH AVE
CAPE CORAL FL
33993-4941
US

V. Phone/Fax

Practice location:
  • Phone: 786-226-5097
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11036175
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: