Provider Demographics
NPI:1245780162
Name:HERNANDO HEALTHCARE ASSOCIATES, PA
Entity Type:Organization
Organization Name:HERNANDO HEALTHCARE ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ANTON
Authorized Official - Last Name:ERNANDES
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT, PHD
Authorized Official - Phone:352-586-5311
Mailing Address - Street 1:15468 DURANGO CIR
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34604-5009
Mailing Address - Country:US
Mailing Address - Phone:352-586-5311
Mailing Address - Fax:
Practice Address - Street 1:15468 DURANGO CIR
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34604-5009
Practice Address - Country:US
Practice Address - Phone:352-586-5311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT6556261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy