Provider Demographics
NPI:1457496598
Name:HERNANDEZ, JOHNANNA LEA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JOHNANNA
Middle Name:LEA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JOHNANNA
Other - Middle Name:
Other - Last Name:HARTSFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:9001 WATERMAN DR
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:76227-5758
Mailing Address - Country:US
Mailing Address - Phone:972-971-9283
Mailing Address - Fax:
Practice Address - Street 1:4885 ELDORADO PKWY
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-8662
Practice Address - Country:US
Practice Address - Phone:972-971-9283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX641294363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84P585Medicare ID - Type Unspecified
TXP73287Medicare UPIN