Basic Information
| Provider Information | |||||||||
| NPI: | 1467705640 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HATZ | ||||||||
| FirstName: | ELIZABETH | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14690 SPRING HILL DR | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SPRING HILL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346098102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527990046 | ||||||||
| FaxNumber: | 3527990042 | ||||||||
| Practice Location | |||||||||
| Address1: | 1700 SE HILLMOOR DR STE 501 | ||||||||
| Address2: | |||||||||
| City: | PORT SAINT LUCIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349527536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722127049 | ||||||||
| FaxNumber: | 7722127059 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2012 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | UO 3151 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | OS12757 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1519W | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER | 015111800 | 05 | FL | MEDICAID |