Healthcare Provider Details

I. General information

NPI: 1891321816
Provider Name (Legal Business Name): MRS. KADIJA HURST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. KADIJA PEART

II. Dates (important events)

Enumeration Date: 03/21/2020
Last Update Date: 03/21/2020
Certification Date: 03/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 N 9TH AVE
PENSACOLA FL
32504-8721
US

IV. Provider business mailing address

6016 YELLOW ROSE DR
PENSACOLA FL
32526-1156
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-7000
  • Fax:
Mailing address:
  • Phone: 850-525-8518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9384844
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: