Provider Demographics
NPI: | 1467177246 |
---|---|
Name: | HERNANDEZ, LINZY ANGELLE (APRN-CNP) |
Entity Type: | Individual |
Prefix: | |
First Name: | LINZY |
Middle Name: | ANGELLE |
Last Name: | HERNANDEZ |
Suffix: | |
Gender: | F |
Credentials: | APRN-CNP |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 113 MICHAEL JOHN DR |
Mailing Address - Street 2: | |
Mailing Address - City: | MAURICE |
Mailing Address - State: | LA |
Mailing Address - Zip Code: | 70555-3387 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 337-322-4170 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4600 AMBASSADOR CAFFERY PKWY |
Practice Address - Street 2: | |
Practice Address - City: | LAFAYETTE |
Practice Address - State: | LA |
Practice Address - Zip Code: | 70508-6902 |
Practice Address - Country: | US |
Practice Address - Phone: | 337-470-5500 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2022-10-05 |
Last Update Date: | 2023-02-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
LA | RN149273 | 163WN0002X |
LA | 229547 | 363LN0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LN0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal |
No | 163WN0002X | Nursing Service Providers | Registered Nurse | Neonatal Intensive Care |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
LA | RN149273 | Other | LSBN |
LA | 229547 | Other | LSBN |