Healthcare Provider Details

I. General information

NPI: 1861125007
Provider Name (Legal Business Name): MICHAEL HURST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 NE 16TH AVE
GAINESVILLE FL
32601-4541
US

IV. Provider business mailing address

745 ORIENTA AVE
ALTAMONTE SPRINGS FL
32701-5619
US

V. Phone/Fax

Practice location:
  • Phone: 877-823-4283
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: