Healthcare Provider Details

I. General information

NPI: 1083477962
Provider Name (Legal Business Name): ELIANA HERNANDEZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2024
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 6TH ST SE
WINTER HAVEN FL
33880-4605
US

IV. Provider business mailing address

4774 WHITE SANDERLING CT
TAMPA FL
33619-0821
US

V. Phone/Fax

Practice location:
  • Phone: 863-419-9301
  • Fax:
Mailing address:
  • Phone: 813-408-3605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number9118398
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: