Healthcare Provider Details

I. General information

NPI: 1396357471
Provider Name (Legal Business Name): LEANNA C HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8933 SW 49TH ST
COOPER CITY FL
33328-3603
US

IV. Provider business mailing address

8933 SW 49TH ST
COOPER CITY FL
33328-3603
US

V. Phone/Fax

Practice location:
  • Phone: 954-309-1338
  • Fax:
Mailing address:
  • Phone: 954-309-1338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: