Provider Demographics
NPI:1689376352
Name:HURST, EZRA TYSON (FNP-C)
Entity Type:Individual
Prefix:
First Name:EZRA
Middle Name:TYSON
Last Name:HURST
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2351 S RIVER RD STE 5
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-8749
Mailing Address - Country:US
Mailing Address - Phone:435-709-8786
Mailing Address - Fax:
Practice Address - Street 1:2351 S RIVER RD STE 5
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-8749
Practice Address - Country:US
Practice Address - Phone:435-709-8786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7341282-4405363LA2100X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care