Basic Information
| Provider Information | |||||||||
| NPI: | 1679533921 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | HERNANDEZ | ||||||||
| FirstName: | AUGUSTIN | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4631 NW 31ST AVE | ||||||||
| Address2: | C/O ANESCO CENTRAL LLC #128 | ||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333093433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544855666 | ||||||||
| FaxNumber: | 9544841651 | ||||||||
| Practice Location | |||||||||
| Address1: | 5000 W OAKLAND PARK BLVD | ||||||||
| Address2: | C/O FLORIDA MEDICAL CENTER | ||||||||
| City: | LAUDERDALE LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333131503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547356000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | ARNP821252 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.