MEDICARE: KEISHLA HERNANDEZ CRUZ 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	363LF0000X	Family Nurse Practitioner	11047214	FL

General Provider Information

NPI Number	:	1851223127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEISHLA HERNANDEZ CRUZ FNP

Provider Business Mailing Address
First Line	:	722 ASHWORTH OVERLOOK DR
Second Line	:
City	:	APOPKA
State	:	FL
Zip	:	32712-3347
Country	:	US
Telephone Number	:	689-209-8947
Fax Number	:

Provider Business Practice Location Address
First Line	:	1825 SALK AVE
Second Line	:
City	:	TAVARES
State	:	FL
Zip	:	32778-4311
Country	:	US
Telephone Number	:	689-209-8947
Fax Number	:

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

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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