Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 11012411 | FL |
NPI | 1780259143 |
---|---|
Provider Name | Maria Teresa Perez Hernandez |
First Address | Tampa, FL 33619-7057 |
Second Address | Tampa, FL 33619-7057 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2021 |
Last Update Date | 26/05/2021 |