Healthcare Provider Details

I. General information

NPI: 1972427144
Provider Name (Legal Business Name): SAMANTHA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

2055 WOOD ST STE 200
SARASOTA FL
34237-7929
US

IV. Provider business mailing address

23310 ALASKA AVE
PORT CHARLOTTE FL
33952-1818
US

V. Phone/Fax

Practice location:
  • Phone: 941-209-8105
  • Fax:
Mailing address:
  • Phone: 941-447-0009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP4687
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: