1376205591 NPI number — MS. JAYE LORINE HURTIN FNP-BC

Table of content: DR. BRYAN STEWART HOLTZMAN MD (NPI 1740920131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376205591 NPI number — MS. JAYE LORINE HURTIN FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HURTIN
Provider First Name:
JAYE
Provider Middle Name:
LORINE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HURTIN-LEAZOTT
Provider Other First Name:
JAYE
Provider Other Middle Name:
LORINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN, FNP-BC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1376205591
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2060 W 24TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YUMA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85364-6123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-819-8834
Provider Business Mailing Address Fax Number:
928-539-5579

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10425 WILLIAMS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLTON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-785-3256
Provider Business Practice Location Address Fax Number:
928-785-3258
Provider Enumeration Date:
10/06/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  STUDENT , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 270896 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 124179 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114623200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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