Healthcare Provider Details

I. General information

NPI: 1841741790
Provider Name (Legal Business Name): JEANETTE HERNANDEZ APRN, MW, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2016
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2665 STATE ROAD 580
CLEARWATER FL
33761-3166
US

IV. Provider business mailing address

PO BOX 748817
ATLANTA GA
30374-8817
US

V. Phone/Fax

Practice location:
  • Phone: 727-725-5121
  • Fax: 877-409-1379
Mailing address:
  • Phone: 813-286-0033
  • Fax: 813-282-1806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11019069
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: