Basic Information
| Provider Information | |||||||||
| NPI: | 1174901177 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DORSEY | ||||||||
| FirstName: | HAZEL | ||||||||
| MiddleName: | BARBARA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MS, ARNP, AGNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7443 CITRUS BLOSSOM DR | ||||||||
| Address2: | |||||||||
| City: | LAND O LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346377466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8134804048 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3617 W HILLSBOROUGH AVE | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336145713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8446654827 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2015 | ||||||||
| LastUpdateDate: | 05/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | ARNP2061962 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.