Healthcare Provider Details

I. General information

NPI: 1073456596
Provider Name (Legal Business Name): MS. IDALMIS HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6161 WATERFORD DISTRICT DR STE 170
MIAMI FL
33126-2045
US

IV. Provider business mailing address

3627 NW 196TH LN
MIAMI GARDENS FL
33056-2251
US

V. Phone/Fax

Practice location:
  • Phone: 786-388-1400
  • Fax:
Mailing address:
  • Phone: 786-873-0838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11046587
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: