Provider Demographics
NPI:1639569973
Name:HURT, SARAH (LMT, COTA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:HURT
Suffix:
Gender:F
Credentials:LMT, COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 140093
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-0093
Mailing Address - Country:US
Mailing Address - Phone:772-201-0972
Mailing Address - Fax:
Practice Address - Street 1:819 RIVERS CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-8328
Practice Address - Country:US
Practice Address - Phone:772-201-0972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13499364SX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SX0106XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOccupational Health