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General NPI Number Information
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NPI Number | 1912138512
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Entity Type | Individual
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Provider Name | HAZELINE KATHERINE MCCABE PA
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Gender | Female
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Dates
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Enumeration Date | 07/30/2009
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Last Update Date | 03/14/2016
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Provider Practice Location Address
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Address Line | 1361 13TH AVE S STE 150
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-3233
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Country | US
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Telephone | 904-242-7177
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Fax | 904-242-7433
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Provider Business Mailing Address
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Address Line | PO BOX 44008 UFJP - PROVIDER ENROLLMENT
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City | JACKSONVILLE
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State | FL
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Zip | 32231-4008
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Country | US
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Telephone | 904-244-3199
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Fax | 904-244-3425
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9105029
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License Number State | FL
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