Provider Demographics
NPI:1245928613
Name:HURLEY, NICOLE (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:HURLEY
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 SE ORCHARD DR APT 3
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-5028
Mailing Address - Country:US
Mailing Address - Phone:360-941-6687
Mailing Address - Fax:
Practice Address - Street 1:4700 EXCHANGE CT STE 185
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-4000
Practice Address - Country:US
Practice Address - Phone:877-345-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61424464363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant