Provider Demographics
NPI:1003311739
Name:HOGAN, SANDRA KENNEDY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:KENNEDY
Last Name:HOGAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 TAMIAMI TRL N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5623
Mailing Address - Country:US
Mailing Address - Phone:239-732-1133
Mailing Address - Fax:239-732-1145
Practice Address - Street 1:599 TAMIAMI TRL N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5623
Practice Address - Country:US
Practice Address - Phone:239-732-1133
Practice Address - Fax:239-732-1145
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN411991164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPN411991OtherSTATE LISCENSE