Healthcare Provider Details

I. General information

NPI: 1962138594
Provider Name (Legal Business Name): MATTHEW HURST ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4655 SALISBURY RD STE 220
JACKSONVILLE FL
32256-0959
US

IV. Provider business mailing address

4655 SALISBURY RD STE 220
JACKSONVILLE FL
32256-0959
US

V. Phone/Fax

Practice location:
  • Phone: 904-570-9404
  • Fax:
Mailing address:
  • Phone: 904-570-9404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11018622
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: