MEDICARE: DR. YOHAN HERNANDEZ FLORES FNP

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	2083S0010X	Sports Medicine (Preventive Medicine) Physician	26NJ15079100	NJ
2	363LF0000X	Family Nurse Practitioner	26NJ15079100	NJ

General Provider Information

NPI Number	:	1295576601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YOHAN HERNANDEZ FLORES FNP

Provider Business Mailing Address
First Line	:	37 BELLEVUE AVE
Second Line	:
City	:	BLOOMFIELD
State	:	NJ
Zip	:	07003-3033
Country	:	US
Telephone Number	:	551-666-2661
Fax Number	:

Provider Business Practice Location Address
First Line	:	76 PROSPECT ST
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07105-1881
Country	:	US
Telephone Number	:	551-666-2661
Fax Number	:

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

Provider Enumeration Date	:	06/03/2024
Last Update Date	:	06/11/2024

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