Healthcare Provider Details

I. General information

NPI: 1366131831
Provider Name (Legal Business Name): JACQUELINE RENEE HERNANDEZ CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11398 BANDERA RD
SAN ANTONIO TX
78250-6840
US

IV. Provider business mailing address

14100 SAN PEDRO AVE STE 600
SAN ANTONIO TX
78232-4363
US

V. Phone/Fax

Practice location:
  • Phone: 210-988-4751
  • Fax:
Mailing address:
  • Phone: 210-281-8669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1113002
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1113002
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: