Healthcare Provider Details

I. General information

NPI: 1518339902
Provider Name (Legal Business Name): DUSTIN HUERTA DNP, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2015
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13640 STEELECROFT PKWY
CHARLOTTE NC
28278-7565
US

IV. Provider business mailing address

13640 STEELECROFT PKWY
CHARLOTTE NC
28278-7565
US

V. Phone/Fax

Practice location:
  • Phone: 704-512-5100
  • Fax:
Mailing address:
  • Phone: 704-512-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5008134
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: