Healthcare Provider Details

I. General information

NPI: 1518292127
Provider Name (Legal Business Name): DAPHNE M. HERNANDEZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2009
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 HILLPOINT BLVD S
SUFFOLK VA
23434
US

IV. Provider business mailing address

1009 HILLPOINT BLVD S
SUFFOLK VA
23434
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-2250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024165148
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: