Healthcare Provider Details

I. General information

NPI: 1063294197
Provider Name (Legal Business Name): TAMPA GENERAL HOSPITAL HERNANDO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2023
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17240 CORTEZ BLVD
BROOKSVILLE FL
34601-8921
US

IV. Provider business mailing address

PO BOX 1289
TAMPA FL
33601-1289
US

V. Phone/Fax

Practice location:
  • Phone: 352-796-5111
  • Fax: 352-544-5711
Mailing address:
  • Phone: 813-844-3956
  • Fax: 813-844-4712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MARK RUNYON
Title or Position: EVP CHIEF FINANCIAL OFCR FHSC
Credential:
Phone: 813-844-4805