Provider Demographics
NPI:1649453234
Name:HERNANDO, HENEDINE CLARK (ARNP)
Entity type:Individual
Prefix:
First Name:HENEDINE
Middle Name:CLARK
Last Name:HERNANDO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 S J ST FL 4
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4930
Mailing Address - Country:US
Mailing Address - Phone:253-207-4200
Mailing Address - Fax:253-207-4285
Practice Address - Street 1:1901 S UNION AVE
Practice Address - Street 2:A221
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1702
Practice Address - Country:US
Practice Address - Phone:253-459-6231
Practice Address - Fax:253-459-6858
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60212754363L00000X, 363LA2200X, 363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2012633Medicaid
ARMH1698933OtherDEA