Provider Demographics
NPI: | 1477017606 |
---|---|
Name: | HAZELRIGG, ASHLEY TORRONI (APRN) |
Entity Type: | Individual |
Prefix: | |
First Name: | ASHLEY |
Middle Name: | TORRONI |
Last Name: | HAZELRIGG |
Suffix: | |
Gender: | F |
Credentials: | APRN |
Other - Prefix: | DR |
Other - First Name: | ASHLEY |
Other - Middle Name: | TORRONI |
Other - Last Name: | HAZELRIGG |
Other - Suffix: | |
Other - Last Name Type: | Professional Name |
Other - Credentials: | DNP |
Mailing Address - Street 1: | PO BOX 743904 |
Mailing Address - Street 2: | |
Mailing Address - City: | ATLANTA |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30374-3904 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 803-296-7320 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 103 SUM MOR DR |
Practice Address - Street 2: | |
Practice Address - City: | WEST COLUMBIA |
Practice Address - State: | SC |
Practice Address - Zip Code: | 29169-4828 |
Practice Address - Country: | US |
Practice Address - Phone: | 803-254-4699 |
Practice Address - Fax: | 803-851-1235 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2019-01-22 |
Last Update Date: | 2023-09-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
SC | 22425 | 2086S0129X, 363LA2100X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LA2100X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No | 2086S0129X | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
SC | NP5798 | Medicaid |