Provider Demographics
NPI:1225762347
Name:BAGEN, TORI A (APRN)
Entity Type:Individual
Prefix:
First Name:TORI
Middle Name:A
Last Name:BAGEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TORI
Other - Middle Name:NELSON
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1025 NW 101ST DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-8034
Mailing Address - Country:US
Mailing Address - Phone:561-351-2324
Mailing Address - Fax:
Practice Address - Street 1:1505 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1134
Practice Address - Country:US
Practice Address - Phone:352-265-9928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11020626363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily