Healthcare Provider Details

I. General information

NPI: 1700796034
Provider Name (Legal Business Name): GINA HERNANDEZ LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 LINDA LN
JACKSONVILLE AR
72076-2851
US

IV. Provider business mailing address

18 PATTY LN
SHERWOOD AR
72120-2608
US

V. Phone/Fax

Practice location:
  • Phone: 501-457-8300
  • Fax:
Mailing address:
  • Phone: 501-749-5559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL042084
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: