Healthcare Provider Details

I. General information

NPI: 1609316041
Provider Name (Legal Business Name): DR. RITA HAZBOUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2017
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 N 9TH AVE
PENSACOLA FL
32504-8721
US

IV. Provider business mailing address

5151 N 9TH AVE
PENSACOLA FL
32504-8721
US

V. Phone/Fax

Practice location:
  • Phone: 740-593-5551
  • Fax:
Mailing address:
  • Phone: 740-593-5551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberME168822
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: