Healthcare Provider Details

I. General information

NPI: 1639569973
Provider Name (Legal Business Name): SARAH HURT LMT, COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 01/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 RIVERS CT
ORLANDO FL
32828-8328
US

IV. Provider business mailing address

PO BOX 140093
ORLANDO FL
32814-0093
US

V. Phone/Fax

Practice location:
  • Phone: 772-201-0972
  • Fax:
Mailing address:
  • Phone: 772-201-0972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SX0106X
TaxonomyOccupational Health Clinical Nurse Specialist
License Number13499
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: