Healthcare Provider Details

I. General information

NPI: 1194054312
Provider Name (Legal Business Name): PHILLIP ROSS HURD FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2009
Last Update Date: 05/27/2024
Certification Date: 05/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 W HIGHWAY 98
PENSACOLA FL
32512-3011
US

IV. Provider business mailing address

6000 W HIGHWAY 98
PENSACOLA FL
32512-0001
US

V. Phone/Fax

Practice location:
  • Phone: 901-874-4202
  • Fax: 840-452-5638
Mailing address:
  • Phone: 901-874-4202
  • Fax: 850-452-5638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2009037132
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: