Healthcare Provider Details

I. General information

NPI: 1366535320
Provider Name (Legal Business Name): TATIANA LUZ HERNANDEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3633 LITTLE RD SUITE 103
TRINITY FL
34655-1815
US

IV. Provider business mailing address

3633 LITTLE RD SUITE 103
TRINITY FL
34655-1815
US

V. Phone/Fax

Practice location:
  • Phone: 727-853-1800
  • Fax: 727-853-1807
Mailing address:
  • Phone: 727-853-1800
  • Fax: 727-853-1807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME90671
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: