Healthcare Provider Details

I. General information

NPI: 1467705640
Provider Name (Legal Business Name): ELIZABETH HATZ D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 SE HILLMOOR DR STE 501
PORT SAINT LUCIE FL
34952-7536
US

IV. Provider business mailing address

14690 SPRING HILL DR SUITE 101
SPRING HILL FL
34609-8102
US

V. Phone/Fax

Practice location:
  • Phone: 772-212-7049
  • Fax: 772-212-7059
Mailing address:
  • Phone: 352-799-0046
  • Fax: 352-799-0042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberUO 3151
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS12757
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: