Provider Demographics
NPI:1790444370
Name:HERNANDEZ ALFONSO, SANDRO (APRN)
Entity Type:Individual
Prefix:
First Name:SANDRO
Middle Name:
Last Name:HERNANDEZ ALFONSO
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8756 SW 72ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3512
Mailing Address - Country:US
Mailing Address - Phone:786-598-7004
Mailing Address - Fax:786-598-7005
Practice Address - Street 1:8756 SW 72ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3512
Practice Address - Country:US
Practice Address - Phone:865-987-0047
Practice Address - Fax:786-598-7005
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-10
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11016619363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily