Provider Demographics
NPI:1245729300
Name:HURLOCK, NANCY A. (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:NANCY A.
Middle Name:
Last Name:HURLOCK
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 NORTHSIDE DR E STE 160
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-4929
Mailing Address - Country:US
Mailing Address - Phone:912-481-3003
Mailing Address - Fax:
Practice Address - Street 1:430 NORTHSIDE DR E STE 160
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-4929
Practice Address - Country:US
Practice Address - Phone:912-481-3003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-04
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2018002323363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology