Provider Demographics
NPI:1679675540
Name:HERNANDEZ, ALEX (PA)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2465 MCMULLEN-BOOTH ROAD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759
Mailing Address - Country:US
Mailing Address - Phone:727-725-5224
Mailing Address - Fax:727-799-2183
Practice Address - Street 1:2465 MCMULLEN-BOOTH ROAD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759
Practice Address - Country:US
Practice Address - Phone:727-725-5224
Practice Address - Fax:727-799-2183
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100607207R00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291755600Medicaid
FLU1921Medicare PIN