Healthcare Provider Details

I. General information

NPI: 1326082249
Provider Name (Legal Business Name): NELSON ANIBAL HERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date: 10/26/2017
Reactivation Date: 11/02/2017

III. Provider practice location address

7481 W OAKLAND PARK BLVD STE 100
TAMARAC FL
33319-4985
US

IV. Provider business mailing address

1065 NE 125TH STREET SUITE 300
NORTH MIAMI FL
33161-5833
US

V. Phone/Fax

Practice location:
  • Phone: 954-771-7743
  • Fax: 954-771-7748
Mailing address:
  • Phone: 888-852-6672
  • Fax: 786-221-0908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME95198
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME95198
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: