Provider Demographics
NPI:1376953836
Name:HERRERA, EMMA M (MD)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:M
Last Name:HERRERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6675 WESTWOOD BLVD STE 475
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-6027
Mailing Address - Country:US
Mailing Address - Phone:407-845-0330
Mailing Address - Fax:888-972-1752
Practice Address - Street 1:7250 RED BUG LAKE RD STE 1008
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9290
Practice Address - Country:US
Practice Address - Phone:407-542-0911
Practice Address - Fax:407-542-0950
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18922208D00000X
FLACN694208D00000X
FLME151947208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQPFN4OtherFLBLUE
FLIK536YOtherMEDICARE
FL015917100Medicaid