Provider Demographics
NPI:1366673121
Name:HERNANDEZ, YESSICA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:YESSICA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 INDIAN TRAIL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-5553
Mailing Address - Country:US
Mailing Address - Phone:770-931-1333
Mailing Address - Fax:770-931-3111
Practice Address - Street 1:1235 INDIAN TRAIL RD STE 200
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-5553
Practice Address - Country:US
Practice Address - Phone:770-931-1333
Practice Address - Fax:770-931-3111
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104693363A00000X, 363AM0700X
CA53290363A00000X
GA10090363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9104693OtherLICENSE
GA10090OtherLICENSE