Provider Demographics
NPI:1194878595
Name:HERNANDEZ, JOSE NOEL (PA)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:NOEL
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11210 SW 188TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-7529
Mailing Address - Country:US
Mailing Address - Phone:305-884-8880
Mailing Address - Fax:305-884-7740
Practice Address - Street 1:11210 SW 188TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-7529
Practice Address - Country:US
Practice Address - Phone:305-884-8880
Practice Address - Fax:305-884-7740
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100229363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9100229OtherPHYSICIAN ASSISTANT