Provider Demographics
NPI:1578562518
Name:HAZZARD, JEFFREY (ARNP)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:HAZZARD
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13403 BOYETTE RD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-8742
Mailing Address - Country:US
Mailing Address - Phone:813-654-1775
Mailing Address - Fax:813-651-9082
Practice Address - Street 1:13403 BOYETTE RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-8742
Practice Address - Country:US
Practice Address - Phone:813-654-1775
Practice Address - Fax:813-651-9082
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1811402363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS53649Medicare UPIN