Provider Demographics
NPI:1134702822
Name:HERNANDEZ, JOSE L (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:L
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12853 ROCK CLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928-5909
Mailing Address - Country:US
Mailing Address - Phone:915-401-4721
Mailing Address - Fax:
Practice Address - Street 1:4301 N MESA ST STE 101
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-1118
Practice Address - Country:US
Practice Address - Phone:915-542-2352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1036265363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily