Healthcare Provider Details

I. General information

NPI: 1063316107
Provider Name (Legal Business Name): NANCY NATALIA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8180 NW 155TH ST
MIAMI LAKES FL
33016-5871
US

IV. Provider business mailing address

3181 SW 13TH ST APT 310
MIAMI FL
33145-1074
US

V. Phone/Fax

Practice location:
  • Phone: 305-512-9250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH25082
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: