Provider Demographics
NPI:1649201401
Name:HERSHORIN, MASON P (MSN ARNP)
Entity Type:Individual
Prefix:
First Name:MASON
Middle Name:P
Last Name:HERSHORIN
Suffix:
Gender:M
Credentials:MSN ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 SW 99TH TERRACE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-1065
Mailing Address - Country:US
Mailing Address - Phone:954-444-7661
Mailing Address - Fax:954-430-3261
Practice Address - Street 1:311 SW 99TH TERRACE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-1065
Practice Address - Country:US
Practice Address - Phone:954-444-7661
Practice Address - Fax:954-430-3261
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2516442363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL302350800Medicaid
CK3521OtherTRICARE WPS
FL302350800Medicaid
CK3521OtherTRICARE WPS