Healthcare Provider Details

I. General information

NPI: 1669896486
Provider Name (Legal Business Name): THERESE B. HAZELTINE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2014
Last Update Date: 02/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3795 ALT 19 # A1
PALM HARBOR FL
34683-1400
US

IV. Provider business mailing address

7954 ADEN LOOP
NEW PORT RICHEY FL
34655-2724
US

V. Phone/Fax

Practice location:
  • Phone: 727-271-4383
  • Fax:
Mailing address:
  • Phone: 727-271-4383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License NumberMA46785
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: