Provider Demographics
NPI:1568978377
Name:HERRERA, NILDA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:NILDA
Middle Name:
Last Name:HERRERA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 W 71ST PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4827
Mailing Address - Country:US
Mailing Address - Phone:305-510-5881
Mailing Address - Fax:305-824-9538
Practice Address - Street 1:2140 W 68TH ST STE 300
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1815
Practice Address - Country:US
Practice Address - Phone:305-822-4107
Practice Address - Fax:305-822-5086
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-17
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9252960363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024058100Medicaid