MEDICARE: LIZETTE S. HERNANDEZ, M.D., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RA0201X	Allergy & Immunology (Internal Medicine) Physician	ME0064363	FL

General Provider Information

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

Provider Business Mailing Address
First Line	:	3709 W HAMILTON AVE
Second Line	:	SUITE #1
City	:	TAMPA
State	:	FL
Zip	:	33614-4015
Country	:	US
Telephone Number	:	813-933-4826
Fax Number	:	813-931-8595

Provider Business Practice Location Address
First Line	:	3709 W HAMILTON AVE
Second Line	:	SUITE #1
City	:	TAMPA
State	:	FL
Zip	:	33614-4015
Country	:	US
Telephone Number	:	813-933-4826
Fax Number	:	813-931-8595

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LIZETTE SONIA HERNANDEZ
Credential	:	M.D.
Telephone Number	:	813-933-4826

Provider Enumeration Date	:	02/28/2008
Last Update Date	:	02/28/2008

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