Active NPI
Nina Jean Herzog, ACNP-BC
- Nurse Practitioner
- Albuquerque, NM
National Provider Identifier
1780730440
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- CNP01217
- Practice address
- 8208 Louisiana Blvd NE
Suite C
Albuquerque, NM 87113-1757 - Phone
- (505) 858-1222
- Fax
- (505) 858-1224
- NPI assigned
- Jan 26, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acute Care Nurse Practitioner | 363LA2100X | R49167 | TX | |
| Nurse Practitioner | 363L00000X | CNP01217 | NM | Primary |
| Nurse Practitioner | 363L00000X | R49167 | NM |
Addresses
Primary practice location
8208 Louisiana Blvd NE
Suite C
Albuquerque, NM 87113-1757
Mailing address
8208 Louisiana Blvd NE
Suite C
Albuquerque, NM 87113-1757
Phone (505) 858-1222
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| R49167 | Other | TX | BNE LICENSE |
| 2006009954 | Other | MD | ANCC CERTIFICATION |
| 87657317 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CNP01217 | NM | MD | Nurse Practitioner |
| R49167 | TX | MD | Acute Care Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1463702400000",
"number": "1780730440",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8208 LOUISIANA BLVD NE",
"address_2": "SUITE C",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871131757",
"telephone_number": "505-858-1222",
"fax_number": "505-858-1224"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8208 LOUISIANA BLVD NE",
"address_2": "SUITE C",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871131757",
"telephone_number": "505-858-1222",
"fax_number": "505-858-1224"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERZOG",
"first_name": "NINA",
"middle_name": "JEAN",
"credential": "ACNP-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-26",
"last_updated": "2016-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2100X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Acute Care",
"state": "TX",
"license": "R49167",
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "NM",
"license": "CNP01217",
"primary": true
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "NM",
"license": "R49167",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BNE LICENSE",
"identifier": "R49167",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANCC CERTIFICATION",
"identifier": "2006009954",
"state": "MD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "87657317",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.