MEDICARE: MS. IDALMIS 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	363LF0000X	Family Nurse Practitioner	11046587	FL

General Provider Information

NPI Number	:	1073456596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IDALMIS HERNANDEZ

Provider Business Mailing Address
First Line	:	3627 NW 196TH LN
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33056-2251
Country	:	US
Telephone Number	:	786-873-0838
Fax Number	:

Provider Business Practice Location Address
First Line	:	6161 WATERFORD DISTRICT DR STE 170
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-2045
Country	:	US
Telephone Number	:	786-388-1400
Fax Number	:

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

Provider Enumeration Date	:	04/10/2026
Last Update Date	:	04/10/2026

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