MEDICARE: HAZEL DEAN FRASIER PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024176919	VA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	ARNP9170160	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437493285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAZEL DEAN FRASIER PMHNP

Provider Business Mailing Address
First Line	:	9995 GATE PKWY N STE 100
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-0800
Country	:	US
Telephone Number	:	833-769-3524
Fax Number	:	706-410-1490

Provider Business Practice Location Address
First Line	:	9995 GATE PKWY N STE 100
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-0800
Country	:	US
Telephone Number	:	833-769-3524
Fax Number	:	706-410-1490

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2012
Last Update Date	:	11/05/2025

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