Provider Demographics
NPI:1790035921
Name:HERNANDEZ, ELIZABETH (ARNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17121 SW 281ST ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-1905
Mailing Address - Country:US
Mailing Address - Phone:305-505-8421
Mailing Address - Fax:305-675-0340
Practice Address - Street 1:17121 SW 281ST ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-1905
Practice Address - Country:US
Practice Address - Phone:305-505-8421
Practice Address - Fax:305-675-0340
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9308421207PE0004X, 363L00000X, 207PE0004X
COC-APN.0001192-C-NP207QA0505X, 207QA0505X
UT11024407-4405207QA0505X
AZ221040207QA0505X
WY41719.1782207QA0505X
ID59433207QA0505X
NH079057-23207QA0505X
MARN2329972207QA0505X
TXAP139376207QA0505X
NE112600207QA0505X
MECNP181198207QA0505X
OR201807311NP-PP207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS53-78566-052OtherSTATE MEDICAL LICENSE
MI4704348916OtherSTATE MEDICAL LICENSE
MDAC002570OtherSTATE MEDICAL LICENSE
DCRN1051425OtherSTATE MEDICAL LICENSE
IL209.019638OtherSTATE MEDICAL LICENSE
CA95011259OtherSTATE MEDICAL LICENSE
OHAPP-000214651OtherSTATE MEDICAL LICENSE
TN25325OtherSTATE MEDICAL LICENSE
IAC153964OtherSTATE MEDICAL LICENSE
VA24177050OtherSTATE MEDICAL LICENSE