Healthcare Provider Details

I. General information

NPI: 1811807084
Provider Name (Legal Business Name): ANGELICA RITA HERNANDEZ BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W PLUM ST
NOGALES AZ
85621-2613
US

IV. Provider business mailing address

971 PASEO GUEBABI
RIO RICO AZ
85648-2907
US

V. Phone/Fax

Practice location:
  • Phone: 520-287-0800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number13968429-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: