Provider Demographics
NPI:1194790030
Name:ZAMORA, JOSEPHINE HERNANDEZ (RN, ACNS- BC)
Entity type:Individual
Prefix:MRS
First Name:JOSEPHINE
Middle Name:HERNANDEZ
Last Name:ZAMORA
Suffix:
Gender:F
Credentials:RN, ACNS- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 GRAND AVE PARKWAY # 110
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660
Mailing Address - Country:US
Mailing Address - Phone:512-797-0670
Mailing Address - Fax:
Practice Address - Street 1:1620 GRAND AVE PARKWAY # 110
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660
Practice Address - Country:US
Practice Address - Phone:512-670-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX607975364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ59203Medicare UPIN
TX8G1972Medicare ID - Type Unspecified