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General NPI Number Information
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NPI Number | 1730529124
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Entity Type | Individual
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Provider Name | NICOLAY F. HERNANDEZ D.O
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Gender | Male
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Dates
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Enumeration Date | 06/28/2013
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Last Update Date | 08/07/2020
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Provider Practice Location Address
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Address Line | 8201 W BROWARD BLVD
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City | PLANTATION
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State | FL
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Zip | 33324-2701
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Country | US
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Telephone | 954-473-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 12035 LAKE HOUSE LN
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City | PARKLAND
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State | FL
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Zip | 33076-2991
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Country | US
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Telephone | 914-849-8489
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | OS14647
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License Number State | FL
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