MEDICARE: DR. EVELYN HERNANDEZ-GONZALEZ PSYD

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	103T00000X	Psychologist	PY6661	FL

General Provider Information

NPI Number	:	1487396354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EVELYN HERNANDEZ-GONZALEZ PSYD

Provider Business Mailing Address
First Line	:	901 E KENNEDY BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-3502
Country	:	US
Telephone Number	:	813-955-0874
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 E KENNEDY BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-3502
Country	:	US
Telephone Number	:	813-955-0874
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2022
Last Update Date	:	04/11/2022

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