Provider Demographics
NPI:1528798873
Name:HAZELBAKER, SARAH BETH (PA-C)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:BETH
Last Name:HAZELBAKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:870 ROBBIE VW APT 438
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3293
Mailing Address - Country:US
Mailing Address - Phone:812-381-4515
Mailing Address - Fax:
Practice Address - Street 1:3715 PARKMOOR VILLAGE DR STE 102
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5200
Practice Address - Country:US
Practice Address - Phone:812-381-4515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0007415363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant