Provider Demographics
NPI:1083695092
Name:HERNANDEZ, LIZETTE SONIA (MD)
Entity Type:Individual
Prefix:
First Name:LIZETTE
Middle Name:SONIA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709 W HAMILTON AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-4015
Mailing Address - Country:US
Mailing Address - Phone:813-933-4826
Mailing Address - Fax:813-931-8595
Practice Address - Street 1:3709 W HAMILTON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-4015
Practice Address - Country:US
Practice Address - Phone:813-933-4826
Practice Address - Fax:813-931-8595
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0064363207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291911OtherAVMED HEALTH PLAN
FL41857OtherBCBS
FL2128888OtherFIRST HEALTH
FL7080632OtherAETNA HEALTH PLAN