MEDICARE: SANDRA PETRUCCE HURST

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1851891881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA PETRUCCE HURST

Provider Business Mailing Address
First Line	:	4263 WELDON AVE
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-2148
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4263 WELDON AVE
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-2148
Country	:	US
Telephone Number	:	813-220-7834
Fax Number	:

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

Provider Enumeration Date	:	02/16/2018
Last Update Date	:	02/16/2018

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Directions to “ SANDRA PETRUCCE HURST ” Practice Location

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