Provider Demographics
NPI:1003135898
Name:MERCADO, HAZEL ECHAVEZ (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:HAZEL
Middle Name:ECHAVEZ
Last Name:MERCADO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MISS
Other - First Name:HAZEL
Other - Middle Name:ASUTILLA
Other - Last Name:ECHAVEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:10975 E WHITE SAGE DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-9664
Mailing Address - Country:US
Mailing Address - Phone:520-203-7531
Mailing Address - Fax:520-437-0390
Practice Address - Street 1:10975 E WHITE SAGE DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-9664
Practice Address - Country:US
Practice Address - Phone:520-203-7531
Practice Address - Fax:520-437-0390
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3506363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ52739Medicaid
AZ2009004073OtherAMERICAN NURSES CREDENTIALING CENTER (ANCC)
AZAP3506OtherCERTIFICATE OF ADVANCE NURSE PRACTICE AS FAMILY NURSE PRACTITIONER
AZ1003135898OtherNPI
AZ52739Medicaid