Healthcare Provider Details

I. General information

NPI: 1942135553
Provider Name (Legal Business Name): ELSA LEONOR HERNANDEZ HERNANDEZ P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12850 W STATE ROAD 84
DAVIE FL
33325-3396
US

IV. Provider business mailing address

12850 W STATE ROAD 84
DAVIE FL
33325-3396
US

V. Phone/Fax

Practice location:
  • Phone: 786-626-4600
  • Fax:
Mailing address:
  • Phone: 786-626-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3165-P.A.
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: