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General NPI Number Information
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NPI Number | 1760203087
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Entity Type | Individual
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Provider Name | MICHAEL HERNANDEZ
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Gender | Male
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Dates
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Enumeration Date | 10/19/2024
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Last Update Date | 11/26/2025
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Provider Practice Location Address
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Address Line | 10400 GRIFFIN RD STE 201
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City | DAVIE
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State | FL
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Zip | 33328-3321
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Country | US
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Telephone | 954-947-1130
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Fax | 754-315-2744
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Provider Business Mailing Address
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Address Line | 9441 SW 50TH ST
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City | COOPER CITY
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State | FL
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Zip | 33328-4142
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Country | US
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Telephone | 954-947-1130
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Fax | 754-315-2744
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 11036021
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License Number State | FL
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