Healthcare Provider Details

I. General information

NPI: 1518648112
Provider Name (Legal Business Name): BRIDGIT HURST FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 PARKWAY DR
COBLESKILL NY
12043-5150
US

IV. Provider business mailing address

1 ATWELL RD
COOPERSTOWN NY
13326-1394
US

V. Phone/Fax

Practice location:
  • Phone: 518-234-2555
  • Fax: 518-234-3415
Mailing address:
  • Phone: 607-547-3456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number351535
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: