Basic Information
| Provider Information | |||||||||
| NPI: | 1578099719 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERNANDEZ | ||||||||
| FirstName: | DIANA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1533 S BROWNLEE BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784043131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3618842242 | ||||||||
| FaxNumber: | 3618842243 | ||||||||
| Practice Location | |||||||||
| Address1: | 1533 S BROWNLEE BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784043131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3618842242 | ||||||||
| FaxNumber: | 3618842243 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2017 | ||||||||
| LastUpdateDate: | 10/08/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 703127 | TX | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | 363LF0000X | AP136685 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.