Provider Demographics
NPI:1346880739
Name:HILL-LAZENBY, PHAEDRA A (CRNP)
Entity Type:Individual
Prefix:
First Name:PHAEDRA
Middle Name:A
Last Name:HILL-LAZENBY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 JESSE JEWELL PKWY SE STE 400
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3865
Mailing Address - Country:US
Mailing Address - Phone:770-536-9864
Mailing Address - Fax:770-297-5023
Practice Address - Street 1:1250 JESSE JEWELL PKWY SE STE 400
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3865
Practice Address - Country:US
Practice Address - Phone:770-536-9864
Practice Address - Fax:770-297-5023
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-107679363L00000X
GARN299320363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner