Provider Demographics
NPI:1760203087
Name:HERNANDEZ, MICHAEL
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 S STATE ROAD 7 STE 7
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-1711
Mailing Address - Country:US
Mailing Address - Phone:954-295-5825
Mailing Address - Fax:754-315-2744
Practice Address - Street 1:541 S STATE ROAD 7 STE 7
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33068-1711
Practice Address - Country:US
Practice Address - Phone:954-586-4018
Practice Address - Fax:754-551-5344
Is Sole Proprietor?:No
Enumeration Date:2024-10-19
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11036021363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health