Provider Demographics
NPI:1215586870
Name:HERNANDEZ, MARISSA PEREZ (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:PEREZ
Last Name:HERNANDEZ
Suffix:
Gender:F
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 1:4000 PHYSICIANS BLVD STE 211
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-1284
Mailing Address - Country:US
Mailing Address - Phone:661-401-2000
Mailing Address - Fax:
Practice Address - Street 1:4000 PHYSICIANS BLVD STE 211
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1284
Practice Address - Country:US
Practice Address - Phone:661-401-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA813054363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily