Provider Demographics
NPI:1407439623
Name:HERNANDEZ HERNANDEZ, MARITZA LYNN (LPN)
Entity Type:Individual
Prefix:MS
First Name:MARITZA
Middle Name:LYNN
Last Name:HERNANDEZ HERNANDEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:MARITZA
Other - Middle Name:LYNN
Other - Last Name:HERNANDEZ HERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:28 BAHIA PASS TRAK
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34472-8213
Mailing Address - Country:US
Mailing Address - Phone:352-236-9926
Mailing Address - Fax:
Practice Address - Street 1:28 BAHIA PASS TRAK
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34472-8213
Practice Address - Country:US
Practice Address - Phone:352-236-9926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5222062164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse