Provider Demographics
NPI:1023600236
Name:HERNANDEZ, AMANDA MICHELE (PA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MICHELE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 MADISON OAK DR STE 600
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3924
Mailing Address - Country:US
Mailing Address - Phone:972-345-7545
Mailing Address - Fax:
Practice Address - Street 1:4749 FREDERICKSBURG RD STE A
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4465
Practice Address - Country:US
Practice Address - Phone:210-997-8630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14269363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant