Healthcare Provider Details

I. General information

NPI: 1619638582
Provider Name (Legal Business Name): ANNE ELIZABETH HURST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 COLISEUM DR STE 104
HAMPTON VA
23666-5963
US

IV. Provider business mailing address

6350 CENTER DR STE 200
NORFOLK VA
23502-4107
US

V. Phone/Fax

Practice location:
  • Phone: 757-827-9400
  • Fax: 757-827-9320
Mailing address:
  • Phone: 757-213-5700
  • Fax: 757-213-5701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110008713
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: