Provider Demographics
NPI:1316187503
Name:HAZUKA, SARA ROSE (RD, LD/N)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:ROSE
Last Name:HAZUKA
Suffix:
Gender:F
Credentials:RD, LD/N
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:ROSE
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2458 LAKE WOODBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-2712
Mailing Address - Country:US
Mailing Address - Phone:813-313-9881
Mailing Address - Fax:
Practice Address - Street 1:2458 LAKE WOODBERRY CIR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-2712
Practice Address - Country:US
Practice Address - Phone:813-313-9881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-27
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 3868133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered