Healthcare Provider Details

I. General information

NPI: 1164383329
Provider Name (Legal Business Name): JESSICA HERRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 11/18/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10470 SPRING HILL DR
SPRING HILL FL
34608-5044
US

IV. Provider business mailing address

12590 PINES BLVD UNIT 260224
PEMBROKE PINES FL
33026-6512
US

V. Phone/Fax

Practice location:
  • Phone: 954-628-3563
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11041083
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: