Healthcare Provider Details

I. General information

NPI: 1922114859
Provider Name (Legal Business Name): MARY SUZANNE HURLEY APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY SUZANNE TILLEY FNP

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 BENTON AVE
NASHVILLE TN
37204-2303
US

IV. Provider business mailing address

601 BENTON AVE
NASHVILLE TN
37204-2303
US

V. Phone/Fax

Practice location:
  • Phone: 615-292-9770
  • Fax: 615-292-9706
Mailing address:
  • Phone: 615-932-7628
  • Fax: 615-385-1842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN8417
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: