MEDICARE: EUGENE HURST LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	PN5192137	FL

General Provider Information

NPI Number	:	1497373823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUGENE HURST LPN

Provider Business Mailing Address
First Line	:	715 61ST AVE
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32968-9258
Country	:	US
Telephone Number	:	772-453-7315
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 INDIAN RIVER BLVD STE A236
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-7110
Country	:	US
Telephone Number	:	772-242-4596
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2020
Last Update Date	:	07/13/2020

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