Provider Demographics
NPI:1033824388
Name:HERNANDEZ, ANTHONY ENRIQUE (PA-C)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:ENRIQUE
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:692 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-4132
Mailing Address - Country:US
Mailing Address - Phone:786-718-6992
Mailing Address - Fax:
Practice Address - Street 1:2040 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6930
Practice Address - Country:US
Practice Address - Phone:754-348-5001
Practice Address - Fax:754-799-1272
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-20
Last Update Date:2023-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9116684363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant