Provider Demographics
NPI:1811408644
Name:HERNANDEZ, GIBSON ANN (RN, AGPCNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:GIBSON
Middle Name:ANN
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:RN, AGPCNP-BC
Other - Prefix:
Other - First Name:GIBSON
Other - Middle Name:A
Other - Last Name:SINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 746079
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6079
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:
Practice Address - Street 1:4115 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76103-3614
Practice Address - Country:US
Practice Address - Phone:817-796-7370
Practice Address - Fax:817-764-0714
Is Sole Proprietor?:No
Enumeration Date:2017-10-19
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135290363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health