Healthcare Provider Details

I. General information

NPI: 1649935578
Provider Name (Legal Business Name): JESSICA HURST FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 25TH AVE N STE 1204
NASHVILLE TN
37203-1620
US

IV. Provider business mailing address

210 25TH AVE N STE 1204
NASHVILLE TN
37203-1620
US

V. Phone/Fax

Practice location:
  • Phone: 615-843-9387
  • Fax:
Mailing address:
  • Phone: 615-312-0600
  • Fax: 615-320-3259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number29784
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: