Healthcare Provider Details

I. General information

NPI: 1750290581
Provider Name (Legal Business Name): SARA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16801 ORANGE AVE
UMATILLA FL
32784-9252
US

IV. Provider business mailing address

16801 ORANGE AVE
UMATILLA FL
32784-9252
US

V. Phone/Fax

Practice location:
  • Phone: 352-277-4283
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11050323
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: