Provider Demographics
NPI:1902995855
Name:HERNANDEZ, PATRICIA (APRN)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 FARMINGTON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2672
Mailing Address - Country:US
Mailing Address - Phone:860-561-1007
Mailing Address - Fax:860-561-1222
Practice Address - Street 1:1216 FARMINGTON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2672
Practice Address - Country:US
Practice Address - Phone:860-561-1007
Practice Address - Fax:860-561-1222
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002763363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03887OtherMEDICARE GROUP
CT008039644Medicaid
CT500000218OtherMEDICAID GROUP
CT500000218OtherMEDICAID GROUP