Healthcare Provider Details

I. General information

NPI: 1477185593
Provider Name (Legal Business Name): JOSE DANIEL HERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 N ORANGE BLOSSOM TRL
KISSIMMEE FL
34744-2316
US

IV. Provider business mailing address

12245 PIONEERS WAY APT 3304
ORLANDO FL
32832-2850
US

V. Phone/Fax

Practice location:
  • Phone: 407-599-2737
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number173513
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: