Healthcare Provider Details

I. General information

NPI: 1215819792
Provider Name (Legal Business Name): ALIZE HURTIC FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5112 W TAFT RD STE H
LIVERPOOL NY
13088-4991
US

IV. Provider business mailing address

5112 W TAFT RD STE H
LIVERPOOL NY
13088-4991
US

V. Phone/Fax

Practice location:
  • Phone: 315-452-3235
  • Fax: 315-452-5726
Mailing address:
  • Phone: 315-452-3235
  • Fax: 315-452-5726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number357340
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: