Individual
LISA JEANNE BOUMA HERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3464 AVALON PARK EAST BLVD, ORLANDO, FL 32828-7363
(407) 635-3020
(321) 203-4607
Mailing address
3464 AVALON PARK EAST BLVD, ORLANDO, FL 32828-7363
(407) 635-3020
(321) 203-4607
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
276845
NY
208000000X
Pediatrics Physician
Primary
ME166907
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
124579800
—
FL
Enumeration date
01/18/2013
Last updated
09/02/2025
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