Provider Demographics
NPI:1639192453
Name:HERNANDEZ, TESSIE ERINN (RN, MSN, PNP)
Entity Type:Individual
Prefix:MISS
First Name:TESSIE
Middle Name:ERINN
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:RN, MSN, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 PALM TER
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-3713
Mailing Address - Country:US
Mailing Address - Phone:323-697-4940
Mailing Address - Fax:
Practice Address - Street 1:100 W CALIFORNIA BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3010
Practice Address - Country:US
Practice Address - Phone:626-397-3179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA488157163WP0200X, 163WC0200X
CA13006363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WP0200XNursing Service ProvidersRegistered NursePediatrics
Not Answered363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Not Answered163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine