| Doctor Name: | HAZEL MAHATHA |
| NPI Number: | 1104248798 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 18267 |
| Business Practice Address: | 330 Kay Larkin Dr Palatka, FL - 321772307 |
| Business Phone Number: | 3863293780 |
| Business Fax Number: | 3863851269 |
| Mailing Address: | 330 Kay Larkin Dr, PALATKA |
| State: | FL |
| Postal Code: | 321772307 |
| Phone Number: | 3863293780 |
| Fax Number: | 3863851261 |
| NPI Enumeration Date: | 01/15/2014 |
| NPI Last Update Date: | 03/30/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | 18267 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |