Provider Demographics
NPI:1508869975
Name:HERNANDEZ, DEBORAH ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
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 1:3509 22ND ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1307
Mailing Address - Country:US
Mailing Address - Phone:806-799-7928
Mailing Address - Fax:806-788-8500
Practice Address - Street 1:3509 22ND ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1307
Practice Address - Country:US
Practice Address - Phone:806-799-7928
Practice Address - Fax:806-788-8500
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02981363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
8A8539Medicare ID - Type Unspecified
P30912Medicare UPIN