Provider Demographics
NPI:1598064693
Name:HERNANDEZ EGUEZ, CAROLINA DE LOURDES (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINA
Middle Name:DE LOURDES
Last Name:HERNANDEZ EGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5380 PRIMROSE LAKE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647
Mailing Address - Country:US
Mailing Address - Phone:813-769-2778
Mailing Address - Fax:813-769-2779
Practice Address - Street 1:5380 PRIMROSE LAKE CIRCLE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647
Practice Address - Country:US
Practice Address - Phone:813-769-2778
Practice Address - Fax:813-769-2779
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08897200207V00000X
FLME129950207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
334338Medicare PIN