Healthcare Provider Details

I. General information

NPI: 1699056556
Provider Name (Legal Business Name): GISELLE MARIE HERNANDEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 SW 152ND ST
PALMETTO BAY FL
33157-1778
US

IV. Provider business mailing address

1611 NW 12TH AVE # 303
MIAMI FL
33136-1005
US

V. Phone/Fax

Practice location:
  • Phone: 305-251-2500
  • Fax: 478-633-8698
Mailing address:
  • Phone: 305-243-3000
  • Fax: 305-324-7658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME137259
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: