Healthcare Provider Details

I. General information

NPI: 1629066295
Provider Name (Legal Business Name): IVETTE HERNANDEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7729 E PINE LAKE LN
FLORAL CITY FL
34436-3745
US

IV. Provider business mailing address

5400 PINEHURST DR
SPRING HILL FL
34606-3833
US

V. Phone/Fax

Practice location:
  • Phone: 352-765-3003
  • Fax: 352-616-0915
Mailing address:
  • Phone: 352-277-5348
  • Fax: 352-606-2857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME54314
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: