=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720930894
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BROOKE EVELYN HAZY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2026
-----------------------------------------------------
Last Update Date | 02/11/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 NE 19TH DR
-----------------------------------------------------
City | OKEECHOBEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34972-1911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-467-6767
-----------------------------------------------------
Fax | 863-467-1919
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 NE 19TH DR
-----------------------------------------------------
City | OKEECHOBEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34972-1911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-467-6767
-----------------------------------------------------
Fax | 863-467-1919
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | APRN11045455
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------