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General NPI Number Information
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NPI Number | 1396283578
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Entity Type | Individual
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Provider Name | JERRY HERNANDEZ SR. ARNP, FNP-ACAGNP
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Gender | Male
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Dates
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Enumeration Date | 02/07/2017
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Last Update Date | 09/09/2021
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Provider Practice Location Address
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Address Line | 3691 TAMIAMI TRL
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City | PUNTA GORDA
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State | FL
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Zip | 33950-7228
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Country | US
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Telephone | 941-876-8486
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Fax |
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Provider Business Mailing Address
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Address Line | 130 E MARION AVE UNIT 511323
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City | PUNTA GORDA
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State | FL
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Zip | 33951-3662
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Country | US
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Telephone | 941-876-8486
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | ARNP9335689
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License Number State | FL
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