Healthcare Provider Details

I. General information

NPI: 1851223127
Provider Name (Legal Business Name): KEISHLA HERNANDEZ CRUZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 SALK AVE
TAVARES FL
32778-4311
US

IV. Provider business mailing address

2111 SW 20TH PL
OCALA FL
34471-7734
US

V. Phone/Fax

Practice location:
  • Phone: 689-209-8947
  • Fax:
Mailing address:
  • Phone: 352-343-1158
  • Fax: 352-343-8106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11047214
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: