Provider Demographics
NPI:1003000720
Name:HERNANDEZ, OTNIEL (DNP)
Entity Type:Individual
Prefix:DR
First Name:OTNIEL
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 JUNIOR CT
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-2045
Mailing Address - Country:US
Mailing Address - Phone:305-833-4707
Mailing Address - Fax:
Practice Address - Street 1:3677 CENTRAL AVE STE B
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-8226
Practice Address - Country:US
Practice Address - Phone:239-790-1263
Practice Address - Fax:239-790-1074
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5012043363L00000X
FLARNP3081082363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308614300Medicaid
FLAJ034YMedicare PIN