Provider Demographics
NPI:1154060259
Name:HERNANDEZ SERRAT, ISYSMARY
Entity Type:Individual
Prefix:
First Name:ISYSMARY
Middle Name:
Last Name:HERNANDEZ SERRAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3739 MILANO LAKES CIR UNIT 401
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34114-2840
Mailing Address - Country:US
Mailing Address - Phone:407-837-5525
Mailing Address - Fax:
Practice Address - Street 1:3739 MILANO LAKES CIR UNIT 401
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34114-2840
Practice Address - Country:US
Practice Address - Phone:407-837-5525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-217203106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician