Provider Demographics
NPI:1396935755
Name:HERNANDEZ, THERESA M (APN/CNP)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:M
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:APN/CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16100 OZARKS PATH BEECAVE
Mailing Address - Street 2:
Mailing Address - City:BEECAVE
Mailing Address - State:TX
Mailing Address - Zip Code:78738
Mailing Address - Country:US
Mailing Address - Phone:708-278-0095
Mailing Address - Fax:
Practice Address - Street 1:3595 RR 620 S
Practice Address - Street 2:SUITE 150
Practice Address - City:BEECAVE
Practice Address - State:TX
Practice Address - Zip Code:78738
Practice Address - Country:US
Practice Address - Phone:512-781-5615
Practice Address - Fax:833-643-1220
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209006199363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily