Healthcare Provider Details

I. General information

NPI: 1881452704
Provider Name (Legal Business Name): INGRID ISABEL HERNANDEZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 STIRLING RD STE 301
HOLLYWOOD FL
33024-8066
US

IV. Provider business mailing address

3127 NW 84TH WAY
SUNRISE FL
33351-8907
US

V. Phone/Fax

Practice location:
  • Phone: 754-207-0790
  • Fax:
Mailing address:
  • Phone: 754-207-0790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11031577
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: