Provider Demographics
NPI:1225445687
Name:HERNANDEZ, SUSAN MARGARET (AG-ACNP-BC, FNP-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARGARET
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:AG-ACNP-BC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 S HAMPTON RD STE 250
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-2363
Mailing Address - Country:US
Mailing Address - Phone:469-297-3074
Mailing Address - Fax:
Practice Address - Street 1:2701 S HAMPTON RD STE 250
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-2363
Practice Address - Country:US
Practice Address - Phone:469-297-3074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX138569363LA2100X, 363LF0000X
GA297751363LA2100X, 363LF0000X
SC25130363LA2100X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care