Provider Demographics
NPI:1750376307
Name:HAZEL, MICHAEL (RN, FNP-C)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:HAZEL
Suffix:
Gender:M
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 BROSIG AVE
Mailing Address - Street 2:
Mailing Address - City:NAVASOTA
Mailing Address - State:TX
Mailing Address - Zip Code:77868-3102
Mailing Address - Country:US
Mailing Address - Phone:936-825-6185
Mailing Address - Fax:936-825-6186
Practice Address - Street 1:204 BROSIG AVE
Practice Address - Street 2:
Practice Address - City:NAVASOTA
Practice Address - State:TX
Practice Address - Zip Code:77868-3102
Practice Address - Country:US
Practice Address - Phone:936-825-6185
Practice Address - Fax:936-825-6186
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX625218363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP52041Medicare UPIN