Provider Demographics
NPI:1992956098
Name:HERNANDEZ, JOHN FREDERICK (CRNA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:FREDERICK
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 AGNES RD # 200
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-6306
Mailing Address - Country:US
Mailing Address - Phone:615-345-6368
Mailing Address - Fax:
Practice Address - Street 1:2400 UNSER BLVD SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-3392
Practice Address - Country:US
Practice Address - Phone:505-253-7878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN128981367500000X
TXAP119967367500000X, 367500000X
TXRN816792163W00000X
TX816792367500000X
TNAPN13953367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1509815Medicaid
TN4193673OtherBLUE CROSS BLUE SHIELD OF TN
P00664729OtherRAILROAD MEDICARE
TN3600389Medicare UPIN