Healthcare Provider Details

I. General information

NPI: 1104138049
Provider Name (Legal Business Name): REBECCA LYNN HURST MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 TAMPA GENERAL CIR STC 2ND FLOOR
TAMPA FL
33606-3603
US

IV. Provider business mailing address

PO BOX 917770
ORLANDO FL
32891-0001
US

V. Phone/Fax

Practice location:
  • Phone: 813-259-8577
  • Fax:
Mailing address:
  • Phone: 813-974-2201
  • Fax: 813-974-4325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN14928
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME110601
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: