Healthcare Provider Details

I. General information

NPI: 1366776494
Provider Name (Legal Business Name): LUIS ROBERTO HURTADO APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1573 W FAIRBANKS AVE STE 210
WINTER PARK FL
32789-4679
US

IV. Provider business mailing address

1573 W FAIRBANKS AVE STE 210
WINTER PARK FL
32789-4679
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-6729
  • Fax: 407-628-2037
Mailing address:
  • Phone: 407-303-6729
  • Fax: 407-628-2037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9230092
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: