Healthcare Provider Details

I. General information

NPI: 1750808085
Provider Name (Legal Business Name): JENNA HURT FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 08/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 HERITAGE VILLAGE PLZ
GAINESVILLE VA
20155-3078
US

IV. Provider business mailing address

14186 WYNGATE DR
GAINESVILLE VA
20155-1125
US

V. Phone/Fax

Practice location:
  • Phone: 571-248-6100
  • Fax:
Mailing address:
  • Phone: 813-451-1623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024175273
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: