Provider Demographics
NPI:1194054312
Name:HURD, PHILLIP ROSS (FNP)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:ROSS
Last Name:HURD
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 W HIGHWAY 98
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32512-0001
Mailing Address - Country:US
Mailing Address - Phone:901-874-4202
Mailing Address - Fax:850-452-5638
Practice Address - Street 1:6000 W HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32512-3011
Practice Address - Country:US
Practice Address - Phone:901-874-4202
Practice Address - Fax:840-452-5638
Is Sole Proprietor?:No
Enumeration Date:2009-12-17
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009037132363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
502280041Medicare Oscar/Certification