Provider Demographics
NPI:1518339688
Name:HERNANDEZ, JENSEN
Entity Type:Individual
Prefix:
First Name:JENSEN
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 5 BOX 10709
Mailing Address - Street 2:CARR.444 KM2
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-9764
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HC5 BOX 10709
Practice Address - Street 2:ROAD 495
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-2484
Practice Address - Country:US
Practice Address - Phone:787-318-5977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR72414163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice