Provider Demographics
NPI:1528292000
Name:HAZELL, ROSLYN COREEN (FNP)
Entity type:Individual
Prefix:MRS
First Name:ROSLYN
Middle Name:COREEN
Last Name:HAZELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:ROSLYN
Other - Middle Name:COREEN
Other - Last Name:HAZELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:450 LAKEVILLE RD
Mailing Address - Street 2:PRE-SURGICAL TESTING
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1117
Mailing Address - Country:US
Mailing Address - Phone:516-734-8006
Mailing Address - Fax:516-734-8075
Practice Address - Street 1:450 LAKEVILLE RD
Practice Address - Street 2:PRE-SURGICAL TESTING
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1117
Practice Address - Country:US
Practice Address - Phone:516-734-8006
Practice Address - Fax:516-734-8075
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334788363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care