Provider Demographics
NPI:1689221822
Name:JACOBO HERNANDEZ, MARIBEL (APRN)
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:JACOBO HERNANDEZ
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 1:2510 NE 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-5121
Mailing Address - Country:US
Mailing Address - Phone:786-368-4327
Mailing Address - Fax:
Practice Address - Street 1:2510 NE 41ST AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-5121
Practice Address - Country:US
Practice Address - Phone:786-368-4327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF09220993363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily