Healthcare Provider Details

I. General information

NPI: 1376205591
Provider Name (Legal Business Name): JAYE LORINE HURTIN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JAYE LORINE HURTIN-LEAZOTT APRN, FNP-BC

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 08/25/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10425 WILLIAMS ST
WELLTON AZ
85356
US

IV. Provider business mailing address

2060 W 24TH ST
YUMA AZ
85364-6123
US

V. Phone/Fax

Practice location:
  • Phone: 928-785-3256
  • Fax: 928-785-3258
Mailing address:
  • Phone: 928-819-8834
  • Fax: 928-539-5579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSTUDENT
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number270896
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: