Provider Demographics
NPI:1336687656
Name:NIEVES HERNANDEZ, EDWIN (MD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:NIEVES HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 CYPRESS PKWY STE 250
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-3315
Mailing Address - Country:US
Mailing Address - Phone:407-910-1595
Mailing Address - Fax:407-910-7577
Practice Address - Street 1:339 CYPRESS PKWY STE 250
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-3315
Practice Address - Country:US
Practice Address - Phone:407-910-1595
Practice Address - Fax:407-910-1577
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21123208D00000X
FLACN1233208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice