Healthcare Provider Details

I. General information

NPI: 1063200608
Provider Name (Legal Business Name): TANEA RENEE HAZZARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 GREEN RIVER CT
INDIANAPOLIS IN
46229-9500
US

IV. Provider business mailing address

1212 GREEN RIVER CT
INDIANAPOLIS IN
46229-9500
US

V. Phone/Fax

Practice location:
  • Phone: 317-533-0598
  • Fax:
Mailing address:
  • Phone: 317-533-0598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: