Healthcare Provider Details

I. General information

NPI: 1588249213
Provider Name (Legal Business Name): SANDRA HURTUBISE AP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 1ST AVE N
ST PETERSBURG FL
33713-8801
US

IV. Provider business mailing address

5002 29TH AVE N
SAINT PETERSBURG FL
33710-2704
US

V. Phone/Fax

Practice location:
  • Phone: 727-914-7318
  • Fax:
Mailing address:
  • Phone: 713-515-0262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number2069
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: