Healthcare Provider Details

I. General information

NPI: 1700652104
Provider Name (Legal Business Name): DEYSI HURTADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 HISPANA AVE
FORT PIERCE FL
34982-4325
US

IV. Provider business mailing address

1031 HISPANA AVE
FORT PIERCE FL
34982-4325
US

V. Phone/Fax

Practice location:
  • Phone: 772-480-4890
  • Fax:
Mailing address:
  • Phone: 772-480-4890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number202309221
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: