Provider Demographics
NPI:1275138687
Name:HERNANDEZ, CRYSTAL JOE
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:JOE
Last Name:HERNANDEZ
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 1:5903 GRAND LONEOAK LN
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-4874
Mailing Address - Country:US
Mailing Address - Phone:813-545-2556
Mailing Address - Fax:
Practice Address - Street 1:5903 GRAND LONEOAK LN
Practice Address - Street 2:
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547-4874
Practice Address - Country:US
Practice Address - Phone:813-545-2556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Single Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health Aide