Healthcare Provider Details

I. General information

NPI: 1497610562
Provider Name (Legal Business Name): DAVID HERNANDEZ JR. FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2614 BOSTON POST RD STE 16C
GUILFORD CT
06437-1371
US

IV. Provider business mailing address

112 SALTONSTALL PKWY
EAST HAVEN CT
06512-2425
US

V. Phone/Fax

Practice location:
  • Phone: 203-689-5295
  • Fax:
Mailing address:
  • Phone: 203-804-5198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number16046
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: