Provider Demographics
NPI:1043888779
Name:BAZZIE, YATA HAJA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:YATA
Middle Name:HAJA
Last Name:BAZZIE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9409 STREAM VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1924
Mailing Address - Country:US
Mailing Address - Phone:240-475-4161
Mailing Address - Fax:240-318-2001
Practice Address - Street 1:9409 STREAM VALLEY LN
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1924
Practice Address - Country:US
Practice Address - Phone:240-475-4161
Practice Address - Fax:240-318-2001
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRN199031363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily