Provider Demographics
NPI:1174087704
Name:HURST, CARLIN BRAE (FNP-C)
Entity type:Individual
Prefix:
First Name:CARLIN
Middle Name:BRAE
Last Name:HURST
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:CARLIN
Other - Middle Name:
Other - Last Name:BLANCHARD-BLACKBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20783 INTERSTATE 20 S ACCESS RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:TX
Mailing Address - Zip Code:75103-3573
Mailing Address - Country:US
Mailing Address - Phone:402-598-5089
Mailing Address - Fax:
Practice Address - Street 1:20783 INTERSTATE 20 S ACCESS RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:TX
Practice Address - Zip Code:75103-3573
Practice Address - Country:US
Practice Address - Phone:903-567-5437
Practice Address - Fax:844-678-6258
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140364363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily