Siddiqui Rose Hernandez, CRNP PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

AP11103 Issued in AZ

Practice address

123 E Baseline Rd Ste D104
Tempe, AZ 85283-1291

Phone

(480) 718-0568

NPI assigned

Apr 23, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other names 1

• Rosemary Leigh Collins-Simpson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bootheel Counseling Services

  • Community/Behavioral Health Agency
  • Sikeston, MO
  • NPI 1700652898
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577750400000",
    "number": "1235304031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 17779",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850110779",
            "telephone_number": "480-718-0568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 E BASELINE RD STE D104",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852831291",
            "telephone_number": "480-718-0568"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4500 Forbes Blvd",
            "address_2": "Suite 200 E4",
            "address_purpose": "LOCATION",
            "city": "Lanham",
            "state": "MD",
            "postal_code": "207066312",
            "country_code": "US",
            "telephone_number": "443-741-8920",
            "fax_number": "443-203-2617",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2802 E District St",
            "address_purpose": "LOCATION",
            "city": "Tucson",
            "state": "AZ",
            "postal_code": "857142081",
            "country_code": "US",
            "telephone_number": "520-301-2400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HERNANDEZ",
        "first_name": "SIDDIQUI",
        "middle_name": "ROSE",
        "credential": "CRNP PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-23",
        "last_updated": "2019-12-31",
        "certification_date": "2019-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "RN213648",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MO",
            "license": "2010039446",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R205786",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "AP11103",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ROSEMARY",
            "last_name": "COLLINS-SIMPSON",
            "middle_name": "LEIGH",
            "credential": "CRNP PMHNP-BC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Danielle M Hernandez, PT
• Dorothy S. Hernandez, M.ED.
• Elisa Hernandez
• Natalie Hernandez, COTA
• Nicanor Hernandez, MD
• Jeffrey Herndon
• William A Herod Jr., CCP
• Heroes Transportation Inc
• Richard John Herold, PHARM D
• Otilia Elizabeth Herrera Jaimes, SLPA

• Psychiatric/Mental Health Nurse Practitioner in Tempe, AZ
• Providers in Tempe, AZ by specialty
• Psychiatric/Mental Health Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.