Provider Demographics
NPI:1700089950
Name:HERNANDEZ, JENNIFER SCHULTZ (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SCHULTZ
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5928 SILVER SAGE LN
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8758
Mailing Address - Country:US
Mailing Address - Phone:214-287-9763
Mailing Address - Fax:
Practice Address - Street 1:1325 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2158
Practice Address - Country:US
Practice Address - Phone:817-878-5298
Practice Address - Fax:817-878-5289
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7261207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
BP1-0017814OtherINSTITUTIONAL PERMIT