Healthcare Provider Details

I. General information

NPI: 1225501679
Provider Name (Legal Business Name): DANIEL CARL HURST NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 10/12/2024
Certification Date: 10/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3404 W SYLVANIA AVE
TOLEDO OH
43623-4467
US

IV. Provider business mailing address

3404 W SYLVANIA AVE
TOLEDO OH
43623-4467
US

V. Phone/Fax

Practice location:
  • Phone: 419-407-2663
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.024271
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: