Healthcare Provider Details

I. General information

NPI: 1275863227
Provider Name (Legal Business Name): JENNIFER HURLBERT RN, C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2010
Last Update Date: 01/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2226 SWITZER RD
GULFPORT MS
39507-3824
US

IV. Provider business mailing address

12629 CODY DR
GULFPORT MS
39503-7614
US

V. Phone/Fax

Practice location:
  • Phone: 228-897-3709
  • Fax:
Mailing address:
  • Phone: 228-697-9365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR621315
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: