Healthcare Provider Details

I. General information

NPI: 1952221699
Provider Name (Legal Business Name): TEQUILA PRIEUR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TEQUILA HURST

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3118 THOM ST
FLINT MI
48506-2550
US

IV. Provider business mailing address

3118 THOM ST
FLINT MI
48506-2550
US

V. Phone/Fax

Practice location:
  • Phone: 810-297-9310
  • Fax:
Mailing address:
  • Phone: 810-297-9310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: