MEDICARE: DR. GWENDOLYN HERNANDEZ FNP, DNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F340508-1	NY
2	163W00000X	Registered Nurse	22 496055	NY

General Provider Information

NPI Number	:	1831631795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GWENDOLYN HERNANDEZ FNP, DNP

Provider Business Mailing Address
First Line	:	878 VAN DUZER ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-1816
Country	:	US
Telephone Number	:	646-339-2321
Fax Number	:	718-285-4124

Provider Business Practice Location Address
First Line	:	878 VAN DUZER ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-1816
Country	:	US
Telephone Number	:	646-339-2321
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2016
Last Update Date	:	12/03/2025

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