Individual
TAMMY W HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2275 FORTUNE RD, KISSIMMEE, FL 34744-4404
(407) 201-5179
(407) 624-5905
Mailing address
2322 LILY PAD LN, KISSIMMEE, FL 34743-3993
(617) 888-2546
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
RN9194518
FL
163WN1003X
Nutrition Support Registered Nurse
RN9194518
FL
Other
Enumeration date
09/22/2021
Last updated
08/17/2023
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