Provider Demographics
NPI:1568846038
Name:HERIST, ADIENA AMARO (APRN)
Entity Type:Individual
Prefix:
First Name:ADIENA
Middle Name:AMARO
Last Name:HERIST
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2574 SE HEMSING ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-5224
Mailing Address - Country:US
Mailing Address - Phone:954-501-7571
Mailing Address - Fax:
Practice Address - Street 1:9611 W BROWARD BLVD STE 800
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2334
Practice Address - Country:US
Practice Address - Phone:954-924-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9259335363LF0000X
FLARNP9259335363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015286700Medicaid