MEDICARE: QUINN M HAZELLIEF CRNA

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	367500000X	Certified Registered Nurse Anesthetist	APRN11026435	FL
2	367500000X	Certified Registered Nurse Anesthetist	RN9286048	FL
3	367500000X	Certified Registered Nurse Anesthetist	1212537	TX

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	:	1952981953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUINN M HAZELLIEF CRNA

Provider Business Mailing Address
First Line	:	3955 INDIAN RIVER BLVD STE 100
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-4845
Country	:	US
Telephone Number	:	772-569-2330
Fax Number	:	772-569-2630

Provider Business Practice Location Address
First Line	:	421 N 21ST AVE
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-4158
Country	:	US
Telephone Number	:	772-332-9377
Fax Number	:

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

Provider Enumeration Date	:	04/13/2021
Last Update Date	:	01/14/2026

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