Provider Demographics
NPI:1821731530
Name:HERNANDEZ GOMEZ, MARLA ROBIN (CNA)
Entity Type:Individual
Prefix:MS
First Name:MARLA
Middle Name:ROBIN
Last Name:HERNANDEZ GOMEZ
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:MARLA
Other - Middle Name:ROBIN
Other - Last Name:PELLICONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:8730 SPRINGTREE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33637-4309
Mailing Address - Country:US
Mailing Address - Phone:941-894-9304
Mailing Address - Fax:
Practice Address - Street 1:8730 SPRINGTREE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33637-4309
Practice Address - Country:US
Practice Address - Phone:941-894-9304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL121899246Z00000X, 251E00000X, 251J00000X, 315D00000X, 253Z00000X, 376K00000X
374U00000X, 376J00000X
ND94989376K00000X
ARAR016247001559376K00000X
IA334451376K00000X
PA20051957376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
No374U00000XNursing Service Related ProvidersHome Health Aide
No253Z00000XAgenciesIn Home Supportive Care
No376J00000XNursing Service Related ProvidersHomemaker