Provider Demographics
NPI:1003153131
Name:HAGOOD, CHRISTINA (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:HAGOOD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 GASTON AVE
Mailing Address - Street 2:SUITE 100, WEST TOWER
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-3922
Mailing Address - Country:US
Mailing Address - Phone:214-827-3610
Mailing Address - Fax:214-821-4017
Practice Address - Street 1:6301 GASTON AVE
Practice Address - Street 2:SUITE 100, WEST TOWER
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-3922
Practice Address - Country:US
Practice Address - Phone:214-827-3610
Practice Address - Fax:214-821-4017
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX751589363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01174436OtherMCRR
268801YK6JMedicare PIN