Healthcare Provider Details

I. General information

NPI: 1770100349
Provider Name (Legal Business Name): HERNANDO HMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2020
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17240 CORTEZ BLVD
BROOKSVILLE FL
34601-8921
US

IV. Provider business mailing address

17240 CORTEZ BLVD
BROOKSVILLE FL
34601-8921
US

V. Phone/Fax

Practice location:
  • Phone: 352-796-5111
  • Fax: 352-544-5711
Mailing address:
  • Phone: 352-796-5111
  • Fax: 352-544-5711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: PAULA LALOR
Title or Position: DIRECTOR/DELEGATED OFFICIAL
Credential:
Phone: 629-215-3953