Provider Demographics
NPI:1922114859
Name:HURLEY, MARY SUZANNE (APRN, BC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SUZANNE
Last Name:HURLEY
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:SUZANNE
Other - Last Name:TILLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:601 BENTON AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-2303
Mailing Address - Country:US
Mailing Address - Phone:615-932-7628
Mailing Address - Fax:615-385-1842
Practice Address - Street 1:601 BENTON AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-2303
Practice Address - Country:US
Practice Address - Phone:615-292-9770
Practice Address - Fax:615-292-9706
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN8417363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3649558Medicaid
MT1079056OtherDEA
MT1079056OtherDEA
TN3649558Medicaid