Healthcare Provider Details

I. General information

NPI: 1235458860
Provider Name (Legal Business Name): SHEILA A HURST CAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2010
Last Update Date: 05/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 57TH ST # A
HOLMES BEACH FL
34217-1502
US

IV. Provider business mailing address

308 57TH ST # A
HOLMES BEACH FL
34217-1502
US

V. Phone/Fax

Practice location:
  • Phone: 941-448-3940
  • Fax:
Mailing address:
  • Phone: 941-448-3940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4489
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: