Healthcare Provider Details

I. General information

NPI: 1912357443
Provider Name (Legal Business Name): STEPHANIE HERNANDEZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 03/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13734 SW 56TH ST
MIAMI FL
33175-6020
US

IV. Provider business mailing address

900 S PINE ISLAND RD STE 800
PLANTATION FL
33324-3923
US

V. Phone/Fax

Practice location:
  • Phone: 305-387-7211
  • Fax: 305-382-2708
Mailing address:
  • Phone: 305-387-7211
  • Fax: 305-382-2708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN9389999
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: