Healthcare Provider Details

I. General information

NPI: 1841946142
Provider Name (Legal Business Name): JUAN MARRERO HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2022
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3113 LAWTON RD STE 100
ORLANDO FL
32803-3519
US

IV. Provider business mailing address

3113 LAWTON RD STE 100
ORLANDO FL
32803-3519
US

V. Phone/Fax

Practice location:
  • Phone: 321-842-4964
  • Fax: 321-203-4657
Mailing address:
  • Phone: 321-842-4964
  • Fax: 321-203-4657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA121507
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA8659
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: