Healthcare Provider Details

I. General information

NPI: 1801592712
Provider Name (Legal Business Name): JENNY MARIE HURST FAMILY NURSE PRACTIT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 06/17/2025
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11209 N TATUM BLVD #180 PARADISE VALLEY FAMILY MEDICINE
PHOENIX AZ
85028
US

IV. Provider business mailing address

11209 N TATUM BLVD #180 PARADISE VALLEY FAMILY MEDICINE
PHOENIX AZ
85028
US

V. Phone/Fax

Practice location:
  • Phone: 602-494-5155
  • Fax: 602-494-5115
Mailing address:
  • Phone: 602-494-5155
  • Fax: 602-494-5115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10018908
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number200740371RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: