Provider Demographics
NPI:1275863227
Name:HURLBERT, JENNIFER (RN, C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HURLBERT
Suffix:
Gender:F
Credentials:RN, C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12629 CODY DR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-7614
Mailing Address - Country:US
Mailing Address - Phone:228-697-9365
Mailing Address - Fax:
Practice Address - Street 1:2226 SWITZER RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-3824
Practice Address - Country:US
Practice Address - Phone:228-897-3709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR621315163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse