Healthcare Provider Details

I. General information

NPI: 1003380452
Provider Name (Legal Business Name): STEPHANIE D HERNANDEZ AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2019
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9235 E BROADWAY ST
PLANADA CA
95365-8088
US

IV. Provider business mailing address

344 E 6TH ST
MADERA CA
93638-3631
US

V. Phone/Fax

Practice location:
  • Phone: 209-382-0253
  • Fax: 209-382-2110
Mailing address:
  • Phone: 559-664-4000
  • Fax: 559-675-5224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number729012
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95010896
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95010896
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: