Healthcare Provider Details

I. General information

NPI: 1679407662
Provider Name (Legal Business Name): CARLIE HAZLETT CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 COVE FORGE RD
WILLIAMSBURG PA
16693-7138
US

IV. Provider business mailing address

1190 BLOOMFIELD RD
ROARING SPRING PA
16673-8126
US

V. Phone/Fax

Practice location:
  • Phone: 814-832-2131
  • Fax:
Mailing address:
  • Phone: 814-327-9071
  • Fax: 814-327-9071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP036206
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: