Provider Demographics
NPI:1144555814
Name:HERNANDEZ, MARIA D (FNP,WHNP,RN)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:D
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:FNP,WHNP,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-2014
Mailing Address - Country:US
Mailing Address - Phone:956-712-0260
Mailing Address - Fax:
Practice Address - Street 1:209 W VILLAGE BLVD STE 3
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-2227
Practice Address - Country:US
Practice Address - Phone:956-725-5210
Practice Address - Fax:956-717-1708
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX577629363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX742927980OtherTRICARE HUMANA MILITARY