Provider Demographics
NPI:1043284136
Name:HOGAN, RENEE M (ARNP)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:M
Last Name:HOGAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3368 NW 50TH CT
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34482-9303
Mailing Address - Country:US
Mailing Address - Phone:352-867-0676
Mailing Address - Fax:
Practice Address - Street 1:2980 SE 3RD CT
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0421
Practice Address - Country:US
Practice Address - Phone:352-622-4231
Practice Address - Fax:352-622-0513
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL737342363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL97627OtherMEDICARE PIN/GROUP
FLP57562Medicare UPIN
FLY9586YMedicare PIN