Healthcare Provider Details

I. General information

NPI: 1396399747
Provider Name (Legal Business Name): NICOLE HURTADO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 W BLACKWELL ST
DOVER NJ
07801-3841
US

IV. Provider business mailing address

22 WARD AVE
BUTLER NJ
07405-1129
US

V. Phone/Fax

Practice location:
  • Phone: 973-328-3344
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA102306
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MP00535000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: