Provider Demographics
NPI:1427421197
Name:HERNANDEZ, MADELINE (FNP)
Entity type:Individual
Prefix:
First Name:MADELINE
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 1:2064 CROPSEY AVE
Mailing Address - Street 2:SUITE 1G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-6200
Mailing Address - Country:US
Mailing Address - Phone:718-975-8765
Mailing Address - Fax:718-975-8764
Practice Address - Street 1:2064 CROPSEY AVE
Practice Address - Street 2:SUITE 1G
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-6200
Practice Address - Country:US
Practice Address - Phone:718-975-8765
Practice Address - Fax:718-975-8764
Is Sole Proprietor?:No
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339873363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily