Provider Demographics
NPI:1003380452
Name:HERNANDEZ, STEPHANIE D (AGNP)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:D
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 W CHILDS AVE
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95341-6805
Mailing Address - Country:US
Mailing Address - Phone:866-682-4842
Mailing Address - Fax:877-436-1488
Practice Address - Street 1:9235 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PLANADA
Practice Address - State:CA
Practice Address - Zip Code:95365-8088
Practice Address - Country:US
Practice Address - Phone:209-382-0253
Practice Address - Fax:209-382-2110
Is Sole Proprietor?:No
Enumeration Date:2019-01-18
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010896363LA2200X, 363L00000X
CA729012163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse