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NPI Code Detail

MEDICARE: JERRY HERNANDEZ SR. ARNP, FNP-ACAGNP

MEDICARE:   JERRY  HERNANDEZ SR. ARNP, FNP-ACAGNP
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
1363L00000XNurse PractitionerARNP9335689FL

General Provider Information

NPI Number : 1396283578
Entity Type Code : Individual
Provider Name (Legal Business Name) : JERRY HERNANDEZ SR. ARNP, FNP-ACAGNP
Provider Business Mailing Address
First Line : 130 E MARION AVE UNIT 511323
Second Line :
City : PUNTA GORDA
State : FL
Zip : 33951-3662
Country : US
Telephone Number : 941-876-8486
Fax Number :
Provider Business Practice Location Address
First Line : 3691 TAMIAMI TRL
Second Line :
City : PUNTA GORDA
State : FL
Zip : 33950-7228
Country : US
Telephone Number : 941-876-8486
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2017
Last Update Date : 09/09/2021

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Directions to “ JERRY HERNANDEZ SR. ARNP, FNP-ACAGNP” Practice Location

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