Healthcare Provider Details

I. General information

NPI: 1104271725
Provider Name (Legal Business Name): LAURA MARIE HERNANDEZ CRUZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 STATE ROAD 66
SEBRING FL
33875-6265
US

IV. Provider business mailing address

2701 STATE ROAD 66
SEBRING FL
33875-6265
US

V. Phone/Fax

Practice location:
  • Phone: 786-948-6461
  • Fax:
Mailing address:
  • Phone: 786-948-6461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number19319
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME157991
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101275453
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: