Provider Demographics
NPI:1144730540
Name:HERNANDEZ, JENNIFER L (RDN, CSR, LDN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:RDN, CSR, LDN
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:CHILDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, CSR, LDN
Mailing Address - Street 1:121 N COMPASS WAY APT 431
Mailing Address - Street 2:
Mailing Address - City:DANIA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33004-2387
Mailing Address - Country:US
Mailing Address - Phone:520-240-7552
Mailing Address - Fax:575-404-7707
Practice Address - Street 1:121 N COMPASS WAY APT 431
Practice Address - Street 2:
Practice Address - City:DANIA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33004-2387
Practice Address - Country:US
Practice Address - Phone:520-240-7552
Practice Address - Fax:575-404-7707
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1082987133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
1082987OtherCOMMISSION ON DIETETIC REGISTRATION
HI158-LDOtherSTATE OF HAWAII