1982779633 NPI number — MRS. JENNIFER JOHNSON HAZZARD PA-C

Table of content: MRS. JENNIFER JOHNSON HAZZARD PA-C (NPI 1982779633)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982779633 NPI number — MRS. JENNIFER JOHNSON HAZZARD PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAZZARD
Provider First Name:
JENNIFER
Provider Middle Name:
JOHNSON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSON
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982779633
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 69709
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21264-9709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-860-4506
Provider Business Mailing Address Fax Number:
410-860-8593

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1606 SAVANNAH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWES
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19958-1656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-749-4154
Provider Business Practice Location Address Fax Number:
410-860-9583
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  C5-0000566 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 51-0370286 . This is a "EASTERN SUSSEX PHYSICIANS CARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 51-0370286 . This is a "GREAT-WEST HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1982779633 . This is a "BLUE CROSS BLUE SHIELD OF DELAWARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00472436 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1982779633 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51-0370286 . This is a "HEALTH NET - TRICARE/CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 51-0370286 . This is a "UNION LABOR LIFE INSURANCE COMPANY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 51-0370286 . This is a "DEVON HEALTH SERVICES" identifier . This identifiers is of the category "OTHER".




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