Healthcare Provider Details

I. General information

NPI: 1104631407
Provider Name (Legal Business Name): ADRIANA E HERNANDEZ CALDERON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 W 84TH ST STE 101
HIALEAH FL
33016-5771
US

IV. Provider business mailing address

180 NE 29TH ST PH 2006
MIAMI FL
33137-5244
US

V. Phone/Fax

Practice location:
  • Phone: 786-299-2114
  • Fax:
Mailing address:
  • Phone: 765-546-7704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11037608
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number9591081
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: