Healthcare Provider Details

I. General information

NPI: 1821410978
Provider Name (Legal Business Name): CINDY HAZZAH NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2014
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W 38TH ST SUITE 514
AUSTIN TX
78705-1000
US

IV. Provider business mailing address

1301 W 38TH ST SUITE 514
AUSTIN TX
78705-1000
US

V. Phone/Fax

Practice location:
  • Phone: 512-681-0500
  • Fax:
Mailing address:
  • Phone: 512-681-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209.011151
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number209.011151
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: