Healthcare Provider Details

I. General information

NPI: 1376809244
Provider Name (Legal Business Name): AMANDA HURWITZ APRN, MS, ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA COSTELLO

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 04/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ASYLUM AVE SUITE 2109A
HARTFORD CT
06105-1770
US

IV. Provider business mailing address

114 WOODLAND ST DEPT OF SURGERY
HARTFORD CT
06105-1208
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-6581
  • Fax: 860-714-8311
Mailing address:
  • Phone: 860-714-4694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4948
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: