Provider Demographics
NPI:1164543773
Name:FERNANDEZ, GINNY GAYLE (NP)
Entity Type:Individual
Prefix:
First Name:GINNY
Middle Name:GAYLE
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:GINNY
Other - Middle Name:GAYLE
Other - Last Name:DESIMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:190 JORDAN AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-7086
Mailing Address - Country:US
Mailing Address - Phone:559-299-9905
Mailing Address - Fax:559-299-8839
Practice Address - Street 1:7075 N FRESNO ST
Practice Address - Street 2:102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-6851
Practice Address - Country:US
Practice Address - Phone:559-299-8800
Practice Address - Fax:559-299-9944
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA280892363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANPF8889OtherNURSE PRACTITIONER
CA280892OtherCALIFORNIA LICENSE