Provider Demographics
NPI:1013633791
Name:HURST, TIMOTHY (NP)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:HURST
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44687 LA PAZ RD
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-2550
Mailing Address - Country:US
Mailing Address - Phone:661-606-9280
Mailing Address - Fax:
Practice Address - Street 1:44687 LA PAZ RD
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-2550
Practice Address - Country:US
Practice Address - Phone:661-606-9280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022931363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care