Provider Demographics
NPI:1215461090
Name:HERNANDEZ, MARICELA (FNP)
Entity type:Individual
Prefix:MISS
First Name:MARICELA
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:PO BOX 830605
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78283-0605
Mailing Address - Country:US
Mailing Address - Phone:210-222-0333
Mailing Address - Fax:210-928-4837
Practice Address - Street 1:7355 BARLITE BLVD STE 301
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1340
Practice Address - Country:US
Practice Address - Phone:210-222-0333
Practice Address - Fax:210-928-4837
Is Sole Proprietor?:No
Enumeration Date:2017-04-18
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133548363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily