MEDICARE: ERNESTO CORDOVA

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	9364522	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922513324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERNESTO CORDOVA

Provider Business Mailing Address
First Line	:	10700 CITY CENTER BLVD
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33025-4072
Country	:	US
Telephone Number	:	305-343-0069
Fax Number	:

Provider Business Practice Location Address
First Line	:	1140 W 50TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3440
Country	:	US
Telephone Number	:	305-827-0208
Fax Number	:

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

Provider Enumeration Date	:	12/06/2017
Last Update Date	:	12/06/2017

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Directions to “ ERNESTO CORDOVA ” Practice Location

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