Provider Demographics
NPI:1619655560
Name:HERRERA, ADOLPH M
Entity Type:Individual
Prefix:
First Name:ADOLPH
Middle Name:M
Last Name:HERRERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36468 EMERALD COAST PKWY STE 8102
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-0712
Mailing Address - Country:US
Mailing Address - Phone:850-650-9500
Mailing Address - Fax:
Practice Address - Street 1:36468 EMERALD COAST PKWY STE 8102
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-0712
Practice Address - Country:US
Practice Address - Phone:850-650-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11028006363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily