Healthcare Provider Details

I. General information

NPI: 1538329933
Provider Name (Legal Business Name): HERNANDO NEUROSURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17222 HOSPITAL BLVD #350
BROOKSVILLE FL
34601-8925
US

IV. Provider business mailing address

17222 HOSPITAL BLVD #350
BROOKSVILLE FL
34601-8925
US

V. Phone/Fax

Practice location:
  • Phone: 352-796-5111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME82022
License Number StateFL

VIII. Authorized Official

Name: DR. ESTHER L WYLEN
Title or Position: OWNER
Credential: M.D.
Phone: 352-796-5111