Provider Demographics
NPI:1740515758
Name:HERNANDEZ, GRETTY (LPN)
Entity type:Individual
Prefix:MR
First Name:GRETTY
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 E COLONIAL DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-5245
Mailing Address - Country:US
Mailing Address - Phone:407-447-5971
Mailing Address - Fax:407-447-5985
Practice Address - Street 1:3901 E COLONIAL DR
Practice Address - Street 2:SUITE E
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5245
Practice Address - Country:US
Practice Address - Phone:407-447-5971
Practice Address - Fax:407-447-5985
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5169591164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse