Provider Demographics
NPI:1003199720
Name:HAZARD, TIMOTHY E (FNP)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:E
Last Name:HAZARD
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 SOLVANG WAY
Mailing Address - Street 2:
Mailing Address - City:DENMARK
Mailing Address - State:WI
Mailing Address - Zip Code:54208-8951
Mailing Address - Country:US
Mailing Address - Phone:920-863-2600
Mailing Address - Fax:
Practice Address - Street 1:629 SOLVANG WAY
Practice Address - Street 2:
Practice Address - City:DENMARK
Practice Address - State:WI
Practice Address - Zip Code:54208
Practice Address - Country:US
Practice Address - Phone:920-863-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6952363L00000X, 363L00000X
IL209009051363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363F0000XOtherTAXONOMY#
WI1003199720Medicaid
WIK400308774Medicare PIN