MEDICARE: IALA TERESA HURST APRN

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	363L00000X	Nurse Practitioner	APRN11014885	FL

General Provider Information

NPI Number	:	1790452670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IALA TERESA HURST APRN

Provider Business Mailing Address
First Line	:	38135 MARKET SQ
Second Line	:
City	:	ZEPHYRHILLS
State	:	FL
Zip	:	33542-7505
Country	:	US
Telephone Number	:	813-284-2220
Fax Number	:	813-377-1718

Provider Business Practice Location Address
First Line	:	13311 N 56TH ST
Second Line	:
City	:	TEMPLE TERRACE
State	:	FL
Zip	:	33617-1161
Country	:	US
Telephone Number	:	813-284-2220
Fax Number	:	813-377-1718

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

Provider Enumeration Date	:	08/27/2021
Last Update Date	:	03/09/2022

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