Provider Demographics
NPI:1285625079
Name:HERNANDEZ, NELSON D (MD)
Entity type:Individual
Prefix:DR
First Name:NELSON
Middle Name:D
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 CORAL WAY
Mailing Address - Street 2:STE 208
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2934
Mailing Address - Country:US
Mailing Address - Phone:305-854-7952
Mailing Address - Fax:305-854-7953
Practice Address - Street 1:1300 CORAL WAY
Practice Address - Street 2:STE 208
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2934
Practice Address - Country:US
Practice Address - Phone:305-854-7952
Practice Address - Fax:305-854-7953
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2014-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00619212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371252 400Medicaid
FL18045Medicare PIN
FL18045UMedicare PIN
F41362Medicare UPIN