MEDICARE: MICHAEL TYLER 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

General Provider Information

NPI Number	:	1154876787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL TYLER HERNANDEZ

Provider Business Mailing Address
First Line	:	1174 BEECH GROVE WAY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-6916
Country	:	US
Telephone Number	:	561-307-7180
Fax Number	:

Provider Business Practice Location Address
First Line	:	1174 BEECH GROVE WAY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-6916
Country	:	US
Telephone Number	:	561-307-7180
Fax Number	:

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

Provider Enumeration Date	:	08/24/2016
Last Update Date	:	08/24/2016

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