Healthcare Provider Details

I. General information

NPI: 1013186576
Provider Name (Legal Business Name): LIZETTE S. HERNANDEZ, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3709 W HAMILTON AVE SUITE #1
TAMPA FL
33614-4015
US

IV. Provider business mailing address

3709 W HAMILTON AVE SUITE #1
TAMPA FL
33614-4015
US

V. Phone/Fax

Practice location:
  • Phone: 813-933-4826
  • Fax: 813-931-8595
Mailing address:
  • Phone: 813-933-4826
  • Fax: 813-931-8595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberME0064363
License Number StateFL

VIII. Authorized Official

Name: DR. LIZETTE SONIA HERNANDEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 813-933-4826