Healthcare Provider Details

I. General information

NPI: 1265396634
Provider Name (Legal Business Name): TIFFANY HERNANDEZ
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13228 SW 256TH TER
HOMESTEAD FL
33032-6837
US

IV. Provider business mailing address

13228 SW 256TH TER
HOMESTEAD FL
33032-6837
US

V. Phone/Fax

Practice location:
  • Phone: 786-238-5493
  • Fax:
Mailing address:
  • Phone: 786-238-5493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11043991
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: