Provider Demographics
NPI:1699256347
Name:HAZELL, DAMARIS (AG-ACNP)
Entity type:Individual
Prefix:
First Name:DAMARIS
Middle Name:
Last Name:HAZELL
Suffix:
Gender:F
Credentials:AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6423
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-6423
Mailing Address - Country:US
Mailing Address - Phone:480-245-6286
Mailing Address - Fax:480-398-8070
Practice Address - Street 1:8880 E DESERT COVE AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6746
Practice Address - Country:US
Practice Address - Phone:480-314-6670
Practice Address - Fax:480-257-1997
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ218958363LA2100X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care