Provider Demographics
NPI:1336886324
Name:HAZEL, AUDRA ANNE (FNP-BC)
Entity type:Individual
Prefix:
First Name:AUDRA
Middle Name:ANNE
Last Name:HAZEL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:AUDRA
Other - Middle Name:ANNE
Other - Last Name:HAZEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:370 N HAVEN DR STE 101
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6023
Mailing Address - Country:US
Mailing Address - Phone:208-732-2200
Mailing Address - Fax:208-732-2201
Practice Address - Street 1:370 N HAVEN DR STE 101
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6023
Practice Address - Country:US
Practice Address - Phone:208-732-2200
Practice Address - Fax:208-732-2201
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0997524-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily