Healthcare Provider Details

I. General information

NPI: 1386913028
Provider Name (Legal Business Name): RAMONA LEE HERMANSA RSA, CSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RAMONA LEE MURPHY CSA

II. Dates (important events)

Enumeration Date: 12/27/2011
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

834 OAK POND DR
OSPREY FL
34229
US

IV. Provider business mailing address

834 OAK POND DR
OSPREY FL
34229-8997
US

V. Phone/Fax

Practice location:
  • Phone: 217-621-1979
  • Fax: 713-779-9813
Mailing address:
  • Phone: 217-621-1979
  • Fax: 866-563-3374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number23800147
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: