Healthcare Provider Details

I. General information

NPI: 1306751227
Provider Name (Legal Business Name): HERNANY INNOCENT
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15086 PINE MEADOWS DR APT 2
FORT MYERS FL
33908-5114
US

IV. Provider business mailing address

15086 PINE MEADOWS DR APT 2
FORT MYERS FL
33908-5114
US

V. Phone/Fax

Practice location:
  • Phone: 239-287-2952
  • Fax:
Mailing address:
  • Phone: 239-287-2952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: