Healthcare Provider Details

I. General information

NPI: 1013523653
Provider Name (Legal Business Name): TINA MARIE HURLEY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 HEDRICK DR
NEWPORT TN
37821-2902
US

IV. Provider business mailing address

1923 SULPHUR SPRINGS RD
MORRISTOWN TN
37813-5654
US

V. Phone/Fax

Practice location:
  • Phone: 423-623-5301
  • Fax:
Mailing address:
  • Phone: 423-317-9344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000027924
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: