Provider Demographics
NPI:1225560691
Name:BAGAN, ELIZABETH G (ARNP, NP-C, ENP-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:G
Last Name:BAGAN
Suffix:
Gender:F
Credentials:ARNP, NP-C, ENP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14675 STARRATT CREEK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-4468
Mailing Address - Country:US
Mailing Address - Phone:904-613-7337
Mailing Address - Fax:
Practice Address - Street 1:8825 PERIMETER PARK BLVD STE 102
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1127
Practice Address - Country:US
Practice Address - Phone:904-454-4937
Practice Address - Fax:904-293-1325
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2019-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN219604163W00000X
FLRN9319286163WE0003X
FLARNP9319286363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WE0003XNursing Service ProvidersRegistered NurseEmergency