Provider Demographics
NPI:1376205591
Name:HURTIN, JAYE LORINE (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:JAYE
Middle Name:LORINE
Last Name:HURTIN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:JAYE
Other - Middle Name:LORINE
Other - Last Name:HURTIN-LEAZOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP-BC
Mailing Address - Street 1:2060 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6123
Mailing Address - Country:US
Mailing Address - Phone:928-819-8834
Mailing Address - Fax:928-539-5579
Practice Address - Street 1:10425 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:WELLTON
Practice Address - State:AZ
Practice Address - Zip Code:85356
Practice Address - Country:US
Practice Address - Phone:928-785-3256
Practice Address - Fax:928-785-3258
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSTUDENT363L00000X
AZ270896363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ124179Medicaid