Healthcare Provider Details

I. General information

NPI: 1083488688
Provider Name (Legal Business Name): JASMINE IVY HURT RN, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 S 3RD ST FL 5
PHILA PA
19106-2848
US

IV. Provider business mailing address

2053 E CHELTEN AVE
PHILA PA
19138-3043
US

V. Phone/Fax

Practice location:
  • Phone: 215-732-5050
  • Fax:
Mailing address:
  • Phone: 267-205-4610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR19650600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN678522
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: