Healthcare Provider Details

I. General information

NPI: 1790452670
Provider Name (Legal Business Name): IALA TERESA HURST APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2021
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13311 N 56TH ST
TEMPLE TERRACE FL
33617-1161
US

IV. Provider business mailing address

38135 MARKET SQ
ZEPHYRHILLS FL
33542-7505
US

V. Phone/Fax

Practice location:
  • Phone: 813-284-2220
  • Fax: 813-377-1718
Mailing address:
  • Phone: 813-284-2220
  • Fax: 813-377-1718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11014885
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: