Provider Demographics
NPI:1770590622
Name:HERNANDEZ, MINERVA C (MD)
Entity type:Individual
Prefix:
First Name:MINERVA
Middle Name:C
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3053 CARLOW CIR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-3302
Mailing Address - Country:US
Mailing Address - Phone:850-893-2303
Mailing Address - Fax:805-893-2303
Practice Address - Street 1:137 COLLEGIATE WAY - FSU/TSHC
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32306-2140
Practice Address - Country:US
Practice Address - Phone:850-644-5838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME25109207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine