Provider Demographics
NPI:1255799649
Name:HAZZARD, GEORGIA GLENN (CNP)
Entity type:Individual
Prefix:MRS
First Name:GEORGIA
Middle Name:GLENN
Last Name:HAZZARD
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 300
Mailing Address - Street 2:11271 STATE ROUTE 762
Mailing Address - City:ORIENT
Mailing Address - State:OH
Mailing Address - Zip Code:43146-0300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 11271 STATE ROUTE 762
Practice Address - Street 2:
Practice Address - City:ORIENT
Practice Address - State:OH
Practice Address - Zip Code:43146
Practice Address - Country:US
Practice Address - Phone:614-877-2441
Practice Address - Fax:614-877-3853
Is Sole Proprietor?:No
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH17306363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health