Provider Demographics
NPI:1174030670
Name:HERNANDEZ, JESSICA MARGARITA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARGARITA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8130 ROYAL PALM BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5703
Mailing Address - Country:US
Mailing Address - Phone:954-344-6550
Mailing Address - Fax:954-344-8634
Practice Address - Street 1:8130 ROYAL PALM BLVD STE 105
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5703
Practice Address - Country:US
Practice Address - Phone:954-344-6550
Practice Address - Fax:954-344-8634
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-05
Last Update Date:2023-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician