Provider Demographics
NPI:1598023913
Name:HERNANDEZ, AMANDA LEBRIJA (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LEBRIJA
Last Name:HERNANDEZ
Suffix:
Gender:
Credentials:FNP-C
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 36627
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85740-6627
Mailing Address - Country:US
Mailing Address - Phone:520-330-0643
Mailing Address - Fax:520-423-3390
Practice Address - Street 1:2001 W ORANGE GROVE RD STE 308
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1140
Practice Address - Country:US
Practice Address - Phone:520-330-0643
Practice Address - Fax:520-423-3390
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4460363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ155147Medicare PIN