Provider Demographics
NPI:1790485860
Name:HERNANDEZ, EMILY J
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:J
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 1:12426 HORSESHOE BEND DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-3305
Mailing Address - Country:US
Mailing Address - Phone:813-407-7275
Mailing Address - Fax:813-521-7415
Practice Address - Street 1:12426 HORSESHOE BEND DR
Practice Address - Street 2:
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547-3305
Practice Address - Country:US
Practice Address - Phone:813-407-7275
Practice Address - Fax:813-521-7415
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-260752106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician