Healthcare Provider Details

I. General information

NPI: 1497881577
Provider Name (Legal Business Name): NILDAMARYS HERNANDEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1495 BUDINGER AVE
SAINT CLOUD FL
34769-4157
US

IV. Provider business mailing address

6675 WESTWOOD BLVD STE 475
ORLANDO FL
32821-6027
US

V. Phone/Fax

Practice location:
  • Phone: 407-593-9890
  • Fax: 407-910-4795
Mailing address:
  • Phone: 407-845-0330
  • Fax: 888-972-1752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number14362
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN772
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: