MEDICARE: TERESA HERNANDEZ M.D.

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	207Q00000X	Family Medicine Physician	ME0058189	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01319584	OTHER	FL	RAILROAD
2	1043217763	OTHER	FL	MULTIPLAN
3	8282853	OTHER	FL	CIGNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	5915650	OTHER	FL	AETNA
6	1043217763	OTHER	FL	TRICARE
7	25831	OTHER	FL	BCBS
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043217763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA HERNANDEZ M.D.

Provider Business Mailing Address
First Line	:	1184 OCEAN SHORE BLVD
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32176-3763
Country	:	US
Telephone Number	:	386-481-6102
Fax Number	:

Provider Business Practice Location Address
First Line	:	1184 OCEAN SHORE BLVD
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32176-3763
Country	:	US
Telephone Number	:	386-481-6102
Fax Number	:

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	03/19/2021

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