Healthcare Provider Details

I. General information

NPI: 1417691346
Provider Name (Legal Business Name): ARIEL HERNANDEZ JR. RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 W 16TH AVE STE 100
HIALEAH FL
33012-7192
US

IV. Provider business mailing address

6910 W 10TH AVE
HIALEAH FL
33014-5204
US

V. Phone/Fax

Practice location:
  • Phone: 305-558-8687
  • Fax: 305-558-8097
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9539738
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number9539738
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: