Provider Demographics
NPI:1447710322
Name:HERNANDEZ PUENTE, IVONNE
Entity type:Individual
Prefix:
First Name:IVONNE
Middle Name:
Last Name:HERNANDEZ PUENTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:IVONNE
Other - Middle Name:
Other - Last Name:HERNANDEZ PUENTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:1213 SE 16TH TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-6735
Mailing Address - Country:US
Mailing Address - Phone:786-499-5815
Mailing Address - Fax:
Practice Address - Street 1:1682 NE PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-1756
Practice Address - Country:US
Practice Address - Phone:239-424-1600
Practice Address - Fax:239-424-1640
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141079363LF0000X, 363LP2300X
FLAPRN11002493363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
00OtherN/A
FL109643000Medicaid