Individual
NICOLE HERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS, MD
Contact information
Practice address
2711 TAMPA RD, PALM HARBOR, FL 34684-3336
(727) 786-1631
Mailing address
504 W GRAND CENTRAL AVE UNIT 814, TAMPA, FL 33606-1978
(813) 751-5958
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DN24840
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/14/2012
Last updated
08/28/2020
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