Provider Demographics
NPI:1215340534
Name:RIVERA HERNANDEZ, MERCEDES (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:MERCEDES
Middle Name:
Last Name:RIVERA HERNANDEZ
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20444 NW 44TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-1223
Mailing Address - Country:US
Mailing Address - Phone:786-355-9334
Mailing Address - Fax:
Practice Address - Street 1:10401 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3745
Practice Address - Country:US
Practice Address - Phone:305-222-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9335865163W00000X
FL11013941363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse