Healthcare Provider Details

I. General information

NPI: 1073014288
Provider Name (Legal Business Name): TATIANA HIDALGO HERNANDEZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TATIANA HIDALGO

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 SW 152 ST
MIAMI FL
33157
US

IV. Provider business mailing address

21000 NE 28TH AVE STE 104
AVENTURA FL
33180
US

V. Phone/Fax

Practice location:
  • Phone: 305-251-2500
  • Fax:
Mailing address:
  • Phone: 305-974-5533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9336033
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: