Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | MA46785 | FL |
NPI | 1669896486 |
---|---|
Provider Name | Therese B. Hazeltine |
First Address | New Port Richey, FL 34655-2724 |
Second Address | Palm Harbor, FL 34683-1400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2014 |
Last Update Date | 13/02/2014 |