Provider Demographics
NPI:1114808987
Name:EARL, SCOTT JACOB (RN)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:JACOB
Last Name:EARL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 W 100 N
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-2022
Mailing Address - Country:US
Mailing Address - Phone:801-864-1583
Mailing Address - Fax:
Practice Address - Street 1:1403 W 100 N
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-2022
Practice Address - Country:US
Practice Address - Phone:801-864-1583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9675799-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse