Provider Demographics
NPI:1063205912
Name:CALLICOTT, HAZEL BOLTRON (FNP)
Entity type:Individual
Prefix:
First Name:HAZEL
Middle Name:BOLTRON
Last Name:CALLICOTT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 TEATRO CIR
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-5183
Mailing Address - Country:US
Mailing Address - Phone:619-718-2856
Mailing Address - Fax:
Practice Address - Street 1:952 TEATRO CIR
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-5183
Practice Address - Country:US
Practice Address - Phone:619-718-2856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95034167363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily