Provider Demographics
NPI:1033416284
Name:HERNANDEZ LEYVA, WILLIAM (FNP-C, APRN)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:HERNANDEZ LEYVA
Suffix:
Gender:M
Credentials:FNP-C, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2639 WALNUT HILL LN STE 225
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-5699
Mailing Address - Country:US
Mailing Address - Phone:786-603-9409
Mailing Address - Fax:469-654-4091
Practice Address - Street 1:2639 WALNUT HILL LN STE 225
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-5699
Practice Address - Country:US
Practice Address - Phone:469-471-1539
Practice Address - Fax:469-654-4091
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2024-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00448363AS0400X
FL11012909363L00000X
TX1039299363L00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care