Provider Demographics
NPI:1326082249
Name:HERNANDEZ, NELSON ANIBAL (MD)
Entity type:Individual
Prefix:DR
First Name:NELSON
Middle Name:ANIBAL
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 NE 125TH STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5833
Mailing Address - Country:US
Mailing Address - Phone:888-852-6672
Mailing Address - Fax:786-221-0908
Practice Address - Street 1:7481 W OAKLAND PARK BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-4985
Practice Address - Country:US
Practice Address - Phone:954-771-7743
Practice Address - Fax:954-771-7748
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2024-07-03
Deactivation Date:2017-10-26
Deactivation Code:
Reactivation Date:2017-11-02
Provider Licenses
StateLicense IDTaxonomies
FLME951982084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023210100Medicaid
FLU7786UMedicare PIN
FLU7786ZMedicare ID - Type Unspecified
FL275905500Medicaid
FL53693OtherBLUE CROSS & BLUE SHIELD