Provider Demographics
NPI:1396383998
Name:HERNANDEZ, IVETTE LUCIA (APRN, NP-C)
Entity type:Individual
Prefix:MRS
First Name:IVETTE
Middle Name:LUCIA
Last Name:HERNANDEZ
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Gender:F
Credentials:APRN, NP-C
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Mailing Address - Street 1:500 VONDERBURG DR STE 102
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5968
Mailing Address - Country:US
Mailing Address - Phone:813-681-5658
Mailing Address - Fax:813-681-5250
Practice Address - Street 1:4051 UPPER CREEK DR STE 112
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-6825
Practice Address - Country:US
Practice Address - Phone:813-681-5658
Practice Address - Fax:813-681-5250
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2025-04-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11004957363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL117156400Medicaid