Healthcare Provider Details

I. General information

NPI: 1366117145
Provider Name (Legal Business Name): JESSICA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 PEASE ST
HARLINGEN TX
78550-8307
US

IV. Provider business mailing address

3533 S ALAMEDA ST
CORPUS CHRISTI TX
78411-1721
US

V. Phone/Fax

Practice location:
  • Phone: 956-389-1100
  • Fax:
Mailing address:
  • Phone: 361-694-6339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number840993
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: