Provider Demographics
NPI:1528017712
Name:HAZIME, TINA MARCY (NP)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:MARCY
Last Name:HAZIME
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:42484 CHERRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3401
Mailing Address - Country:US
Mailing Address - Phone:734-844-1010
Mailing Address - Fax:734-844-3913
Practice Address - Street 1:42484 CHERRY HILL RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3401
Practice Address - Country:US
Practice Address - Phone:734-844-1010
Practice Address - Fax:734-844-3913
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704172961363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health