Provider Demographics
NPI:1528390663
Name:PROFESSIONAL NURSE PRACTITIONER INC
Entity Type:Organization
Organization Name:PROFESSIONAL NURSE PRACTITIONER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARGARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:305-905-6994
Mailing Address - Street 1:29157 SW 186TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-2439
Mailing Address - Country:US
Mailing Address - Phone:305-905-6994
Mailing Address - Fax:305-245-9994
Practice Address - Street 1:29157 SW 186TH AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-2439
Practice Address - Country:US
Practice Address - Phone:305-905-6994
Practice Address - Fax:305-245-9994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-30
Last Update Date:2010-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2678862363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty