MEDICARE: KIMBERLY 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	225200000X	Physical Therapy Assistant	PTA34051	FL

General Provider Information

NPI Number	:	1093668279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY HERNANDEZ

Provider Business Mailing Address
First Line	:	1018 GIRARD DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32824-5266
Country	:	US
Telephone Number	:	407-963-7278
Fax Number	:

Provider Business Practice Location Address
First Line	:	13574 VILLAGE PARK DR UNIT 200
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32837-7694
Country	:	US
Telephone Number	:	407-930-1000
Fax Number	:

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

Provider Enumeration Date	:	02/18/2026
Last Update Date	:	02/18/2026

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Directions to “ KIMBERLY HERNANDEZ ” Practice Location

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