Healthcare Provider Details

I. General information

NPI: 1194658542
Provider Name (Legal Business Name): DR. HENRY JIM HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

820 BUGLE BRANCH WAY
JACKSONVILLE FL
32259-4449
US

IV. Provider business mailing address

820 BUGLE BRANCH WAY
JACKSONVILLE FL
32259-4449
US

V. Phone/Fax

Practice location:
  • Phone: 904-716-1446
  • Fax:
Mailing address:
  • Phone: 904-716-1446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number29390
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: