Provider Demographics
NPI:1457444531
Name:HERNANDEZ, ANGEL WILFREDO (MD)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:WILFREDO
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANGEL
Other - Middle Name:WILFREDO
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:501 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4634
Mailing Address - Country:US
Mailing Address - Phone:727-898-7451
Mailing Address - Fax:
Practice Address - Street 1:501 6TH AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4634
Practice Address - Country:US
Practice Address - Phone:727-898-7451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010656342084N0402X
NE327632084N0402X
FLME1641412084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00257TOtherMEDICARE GROUP
TX7851240OtherAETNA PIN
H36708Medicare UPIN
TX143749307Medicaid
TX137345810OtherCSHCN GROUP NUMBER
TX115006100OtherFIRSTCARE PIN
TX123996OtherSUPERIOR PIN
TX140442852OtherMEDICAID GROUP NUMBER
TX143749308OtherCSHCN
TX00U87ZOtherBCBSTX GRP PIN
TX143749305OtherCSHCN
1750369203OtherGRP NPI NUMBER
TX143749304Medicaid
TX8L11958Medicare PIN
TX00U87ZOtherMEDICARE GROUP
TX8L6877Medicare PIN
TX150220508OtherMEDICAID GROUP NUMBER
TX2071045OtherUHC PIN
TX7579601OtherCIGNA PIN
TX8A9110OtherBCBSTX IND PIN
TX9165940OtherPHCS PIN
TX10030727OtherAMERIGROUP PIN
150220509OtherCSHCN GROUP NUMBER
TX1912300OtherFIRSTHEALTH PIN