Healthcare Provider Details

I. General information

NPI: 1144382110
Provider Name (Legal Business Name): JOAQUIN HERNANDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 05/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 U,S,1
SAINT AUGUSTINE FL
32086
US

IV. Provider business mailing address

601 SAPORA CIR
SAINT AUGUSTINE FL
32092-4518
US

V. Phone/Fax

Practice location:
  • Phone: 904-494-2841
  • Fax: 904-829-6174
Mailing address:
  • Phone: 904-476-1241
  • Fax: 904-476-1241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number12851
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number12851
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: