1184689259 NPI number — VERLEE L FINES HERNANDEZ M.D.

Table of content: VERLEE L FINES HERNANDEZ M.D. (NPI 1184689259)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184689259 NPI number — VERLEE L FINES HERNANDEZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FINES HERNANDEZ
Provider First Name:
VERLEE
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184689259
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13601 BRUCE B DOWNS BLVD
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33613-4657
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-971-6909
Provider Business Mailing Address Fax Number:
813-971-6985

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13601 BRUCE B DOWNS BLVD
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33613-4657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-971-6909
Provider Business Practice Location Address Fax Number:
813-971-6985
Provider Enumeration Date:
04/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207VM0101X , with the licence number:  ME105759 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 50008182 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64112261 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 065109 . This is a "SIHO" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2627125000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200800830 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1224241 . This is a "CHA / CMA DBA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000379508 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000023025N . This is a "HUMANA / CMA DBA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 966681 . This is a "CIGNA / CMA DBA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 002293000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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