MEDICARE: FOUR WINDS CIRCLE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	ARNP3233312	FL

General Provider Information

NPI Number	:	1659590511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUR WINDS CIRCLE, INC.

Provider Business Mailing Address
First Line	:	6210 UPCOUNTRY DR
Second Line	:
City	:	ZEPHYRHILLS
State	:	FL
Zip	:	33542-2860
Country	:	US
Telephone Number	:	813-486-4612
Fax Number	:	813-778-6762

Provider Business Practice Location Address
First Line	:	6210 UPCOUNTRY DR
Second Line	:
City	:	ZEPHYRHILLS
State	:	FL
Zip	:	33542-2860
Country	:	US
Telephone Number	:	813-486-4612
Fax Number	:	813-778-6762

Authorized Official
Title or Position	:	OWNER NURSE PRACTITIONER
Name	:	SYLVIA LEAN HAZELWOOD
Credential	:	ARNP-C
Telephone Number	:	813-486-4612

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	08/22/2020

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