Healthcare Provider Details

I. General information

NPI: 1518793397
Provider Name (Legal Business Name): HERNANDO PRIMARY HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4169 LAMSON AVE
SPRING HILL FL
34608-3707
US

IV. Provider business mailing address

4169 LAMSON AVE
SPRING HILL FL
34608-3707
US

V. Phone/Fax

Practice location:
  • Phone: 352-667-2828
  • Fax:
Mailing address:
  • Phone: 352-604-9980
  • Fax: 352-309-7452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY LE
Title or Position: BILLING MANAGER
Credential:
Phone: 352-604-9980