MEDICARE: JESSICA HERNANDEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	24866	FL

General Provider Information

NPI Number	:	1033606611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA HERNANDEZ

Provider Business Mailing Address
First Line	:	8785 SW 165TH AVE STE 106D
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33193-5827
Country	:	US
Telephone Number	:	786-391-2935
Fax Number	:	786-409-2019

Provider Business Practice Location Address
First Line	:	8785 SW 165TH AVE STE 106D
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33193-5827
Country	:	US
Telephone Number	:	786-391-2935
Fax Number	:	786-409-2019

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2018
Last Update Date	:	12/04/2025

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