Provider Demographics
NPI:1477782274
Name:HAZELBAKER, DEBORAH YOUNG (RDMS)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:YOUNG
Last Name:HAZELBAKER
Suffix:
Gender:F
Credentials:RDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4181 IONA ST
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2222
Mailing Address - Country:US
Mailing Address - Phone:321-225-4936
Mailing Address - Fax:
Practice Address - Street 1:4181 IONA ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2222
Practice Address - Country:US
Practice Address - Phone:321-225-4936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL57090246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other