Provider Demographics
NPI:1962164327
Name:HERNANDEZ, ARGENIS EDUARDO (PA-C)
Entity type:Individual
Prefix:MR
First Name:ARGENIS
Middle Name:EDUARDO
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 CHAPANOKE RD STE 116
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-3690
Mailing Address - Country:US
Mailing Address - Phone:919-679-9669
Mailing Address - Fax:
Practice Address - Street 1:421 CHAPANOKE RD STE 116
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-3690
Practice Address - Country:US
Practice Address - Phone:919-679-9669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-11669363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant