Provider Demographics
NPI:1306611967
Name:HRUBY, HYACINTH ESCUTIN (CNP)
Entity type:Individual
Prefix:
First Name:HYACINTH
Middle Name:ESCUTIN
Last Name:HRUBY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:HYACINTH
Other - Middle Name:ESCUTIN
Other - Last Name:LICLICAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN CNP
Mailing Address - Street 1:500 HARVARD ST SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0363
Mailing Address - Country:US
Mailing Address - Phone:612-273-8383
Mailing Address - Fax:
Practice Address - Street 1:500 HARVARD ST SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0363
Practice Address - Country:US
Practice Address - Phone:612-273-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-22
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11194363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily