Provider Demographics
NPI:1649645797
Name:HERNANDEZ, ODESSA (FNP)
Entity type:Individual
Prefix:
First Name:ODESSA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1038 E BROKAW RD # 30
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-2309
Mailing Address - Country:US
Mailing Address - Phone:512-784-6767
Mailing Address - Fax:669-500-7491
Practice Address - Street 1:1038 E BROKAW RD # 30
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-2309
Practice Address - Country:US
Practice Address - Phone:512-784-6767
Practice Address - Fax:669-500-7491
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95014055363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily