Provider Demographics
NPI:1437121621
Name:HERNANDEZ, MARIA DEL C (CRNA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DEL C
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:DEL CARMEN
Other - Last Name:HEREDIA ROMERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:160 BOSTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4706
Mailing Address - Country:US
Mailing Address - Phone:407-339-0303
Mailing Address - Fax:407-339-0961
Practice Address - Street 1:1600 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805
Practice Address - Country:US
Practice Address - Phone:863-680-7000
Practice Address - Fax:866-264-8519
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9168145367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305551500Medicaid
FLG3325YMedicare PIN
FL305551500Medicaid