Provider Demographics
NPI:1780788778
Name:TATE, HAZEL MARIE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:HAZEL
Middle Name:MARIE
Last Name:TATE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 W SUNNYDALE DR
Mailing Address - Street 2:#3114
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029
Mailing Address - Country:US
Mailing Address - Phone:602-944-2208
Mailing Address - Fax:
Practice Address - Street 1:10000 N SLOT AVE
Practice Address - Street 2:STE A105 ARETA COUNSELING
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051
Practice Address - Country:US
Practice Address - Phone:602-749-1171
Practice Address - Fax:602-749-8588
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN052975363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0012649OtherDEA