=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760306708
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRINIDAD HERNANDEZ JR. RN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2026
-----------------------------------------------------
Last Update Date | 08/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6965 CUMBERLAND GAP PKWY
-----------------------------------------------------
City | HARROGATE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37752-8231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-869-6830
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 351 MCVEY RD APT 307
-----------------------------------------------------
City | TAZEWELL
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37879-3309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-588-8298
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------