MEDICARE: MR. MIGUEL A HERNANDEZ RN

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	163WA2000X	Administrator Registered Nurse	9393491	FL

General Provider Information

NPI Number	:	1588425847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MIGUEL A HERNANDEZ RN

Provider Business Mailing Address
First Line	:	6708 NW 191ST TER
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-2444
Country	:	US
Telephone Number	:	786-277-6024
Fax Number	:	561-808-8406

Provider Business Practice Location Address
First Line	:	6708 NW 191ST TER
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-2444
Country	:	US
Telephone Number	:	786-277-6024
Fax Number	:	561-808-8406

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

Provider Enumeration Date	:	01/23/2024
Last Update Date	:	10/19/2024

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