Provider Demographics
NPI:1194417436
Name:HERRERA, EDGAR JOSE (RN)
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:JOSE
Last Name:HERRERA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8425 NW 41 ST
Mailing Address - Street 2:APT 307
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33166
Mailing Address - Country:US
Mailing Address - Phone:305-877-0221
Mailing Address - Fax:305-964-5929
Practice Address - Street 1:8425 NW 41 ST
Practice Address - Street 2:APARTMENT 307
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33166
Practice Address - Country:US
Practice Address - Phone:305-877-0221
Practice Address - Fax:305-964-5929
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9380152163WH0200X, 163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Multi-Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty