Healthcare Provider Details

I. General information

NPI: 1891825758
Provider Name (Legal Business Name): JANET P HURLEY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 BOULEVARD STREET
JACKSONVILLE FL
32206-4382
US

IV. Provider business mailing address

1833 BOULEVARD
JACKSONVILLE FL
32206-4382
US

V. Phone/Fax

Practice location:
  • Phone: 904-633-3317
  • Fax:
Mailing address:
  • Phone: 904-633-3317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY6553
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: