Basic Information
Provider Information
NPI: 1003145954
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HERNANDEZ
FirstName: ELIZABETH
MiddleName: MARIE
NamePrefix:  
NameSuffix:  
Credential: RN, MSN, WHCNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 87
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782910087
CountryCode: US
TelephoneNumber: 2103589500
FaxNumber: 2103589183
Practice Location
Address1: 4503 S ZARZAMORA ST
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 78211
CountryCode: US
TelephoneNumber: 2103588255
FaxNumber: 2106448625
Other Information
ProviderEnumerationDate: 12/23/2009
LastUpdateDate: 10/15/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP1700X695964TXN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPerinatal
363LW0102XAP118486TXY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health

No ID Information.


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