Provider Demographics
NPI:1841051083
Name:HERNANDEZ, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
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 1:2050 W CROWN POINTE BLVD APT 211
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-3646
Mailing Address - Country:US
Mailing Address - Phone:786-354-4059
Mailing Address - Fax:
Practice Address - Street 1:2977 GOODLETTE-FRANK RD N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-4612
Practice Address - Country:US
Practice Address - Phone:786-537-9457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLH655200056390106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician