1336428911 NPI number — NICOLE NATIONS HOGUE ARNP

Table of content: NICOLE NATIONS HOGUE ARNP (NPI 1336428911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336428911 NPI number — NICOLE NATIONS HOGUE ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOGUE
Provider First Name:
NICOLE
Provider Middle Name:
NATIONS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NATIONS
Provider Other First Name:
NICOLE
Provider Other Middle Name:
NELL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336428911
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 917770
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32891-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 DAVIS BLVD
Provider Second Line Business Practice Location Address:
STE 402
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33606-3475
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-259-8689
Provider Business Practice Location Address Fax Number:
813-259-8691
Provider Enumeration Date:
08/12/2011

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: 363LF0000X , with the licence number:  ARNP9263176 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 003937700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: Y08QL . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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