Provider Demographics
NPI:1225224496
Name:HERNANDEZ, JEANNETTE (NP-C)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4131 E WINGED FOOT PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-7281
Mailing Address - Country:US
Mailing Address - Phone:480-883-6902
Mailing Address - Fax:
Practice Address - Street 1:2025 N 3RD ST STE 170
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1425
Practice Address - Country:US
Practice Address - Phone:602-794-2612
Practice Address - Fax:602-462-1186
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTAP2855363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health