Healthcare Provider Details

I. General information

NPI: 1538243167
Provider Name (Legal Business Name): JORGE L. HERNANDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 W COLONIAL DR STE 102
OCOEE FL
34761-4213
US

IV. Provider business mailing address

10101 W COLONIAL DR STE 102
OCOEE FL
34761-4213
US

V. Phone/Fax

Practice location:
  • Phone: 407-895-9060
  • Fax: 407-895-9010
Mailing address:
  • Phone: 407-895-9060
  • Fax: 407-895-9010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME0066300
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME0066300
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: