Provider Demographics
NPI:1164601191
Name:TATIANA L HERNANDEZ MD PA
Entity Type:Organization
Organization Name:TATIANA L HERNANDEZ MD PA
Other - Org Name:TRINITY FAMILY HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-853-1800
Mailing Address - Street 1:3633 LITTLE RD
Mailing Address - Street 2:SUITE # 103
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1815
Mailing Address - Country:US
Mailing Address - Phone:727-853-1800
Mailing Address - Fax:727-853-1807
Practice Address - Street 1:3633 LITTLE RD
Practice Address - Street 2:SUITE # 103
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-1815
Practice Address - Country:US
Practice Address - Phone:727-853-1800
Practice Address - Fax:727-853-1807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90671261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI42721Medicare UPIN