Healthcare Provider Details

I. General information

NPI: 1619303633
Provider Name (Legal Business Name): ANGELA JEAN HURST APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA JEAN RITCHEA APRN

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 LAKELAND HILLS BLVD
LAKELAND FL
33805-3019
US

IV. Provider business mailing address

1600 LAKELAND HILLS BLVD
LAKELAND FL
33805-3065
US

V. Phone/Fax

Practice location:
  • Phone: 863-680-7190
  • Fax: 866-264-8519
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9418918
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: