Provider Demographics
NPI:1285994673
Name:HERNANDEZ, AMBER (MA, CCC/SLP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12316 STREAMBED DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-9305
Mailing Address - Country:US
Mailing Address - Phone:321-439-2576
Mailing Address - Fax:
Practice Address - Street 1:4320 BELL SHOALS RD
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-7171
Practice Address - Country:US
Practice Address - Phone:813-643-1389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR200246235Z00000X
FLSA12292235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist