Healthcare Provider Details

I. General information

NPI: 1538936638
Provider Name (Legal Business Name): RANSLAH HURST LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2023
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4237 SALISBURY RD
JACKSONVILLE FL
32216-8029
US

IV. Provider business mailing address

10075 GATE PKWY N 1101
JACKSONVILLE FL
32246-4435
US

V. Phone/Fax

Practice location:
  • Phone: 904-749-4492
  • Fax:
Mailing address:
  • Phone: 478-550-4089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN5240422
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: