Healthcare Provider Details

I. General information

NPI: 1437121621
Provider Name (Legal Business Name): MARIA DEL C HERNANDEZ CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA DEL CARMEN HEREDIA ROMERO

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 LAKELAND HILLS BLVD
LAKELAND FL
33805
US

IV. Provider business mailing address

160 BOSTON AVE
ALTAMONTE SPRINGS FL
32701-4706
US

V. Phone/Fax

Practice location:
  • Phone: 863-680-7000
  • Fax: 866-264-8519
Mailing address:
  • Phone: 407-339-0303
  • Fax: 407-339-0961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9168145
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: