Healthcare Provider Details

I. General information

NPI: 1497373823
Provider Name (Legal Business Name): EUGENE HURST LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 INDIAN RIVER BLVD STE A236
VERO BEACH FL
32960-7110
US

IV. Provider business mailing address

715 61ST AVE
VERO BEACH FL
32968-9258
US

V. Phone/Fax

Practice location:
  • Phone: 772-242-4596
  • Fax:
Mailing address:
  • Phone: 772-453-7315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN5192137
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: