Healthcare Provider Details

I. General information

NPI: 1588552319
Provider Name (Legal Business Name): ASHLEY JADE HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PARK PLACE BLVD STE C1
KISSIMMEE FL
34741-2358
US

IV. Provider business mailing address

5255 IMAGES CIR APT 306
KISSIMMEE FL
34746-4736
US

V. Phone/Fax

Practice location:
  • Phone: 407-385-0728
  • Fax:
Mailing address:
  • Phone: 917-531-5713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-448551
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: