Provider Demographics
NPI:1063200608
Name:HAZZARD, TANEA RENEE
Entity type:Individual
Prefix:
First Name:TANEA
Middle Name:RENEE
Last Name:HAZZARD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 GREEN RIVER CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-9500
Mailing Address - Country:US
Mailing Address - Phone:317-533-0598
Mailing Address - Fax:
Practice Address - Street 1:1212 GREEN RIVER CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-9500
Practice Address - Country:US
Practice Address - Phone:317-533-0598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No251E00000XAgenciesHome Health
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant