Healthcare Provider Details

I. General information

NPI: 1104763523
Provider Name (Legal Business Name): NEVIS HERNANDEZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 NW 57TH AVE
MIAMI FL
33126-2018
US

IV. Provider business mailing address

815 NW 57TH AVE
MIAMI FL
33126-2018
US

V. Phone/Fax

Practice location:
  • Phone: 305-800-2525
  • Fax:
Mailing address:
  • Phone: 305-800-2525
  • Fax: 786-461-1069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11047224
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: