Provider Demographics
NPI:1417617069
Name:HAGANS, CHANDALA MONIQUE (APRN)
Entity Type:Individual
Prefix:
First Name:CHANDALA
Middle Name:MONIQUE
Last Name:HAGANS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 N HOGAN ST # 335
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-4201
Mailing Address - Country:US
Mailing Address - Phone:904-712-3380
Mailing Address - Fax:904-712-6210
Practice Address - Street 1:7317 STEVENTON WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-8179
Practice Address - Country:US
Practice Address - Phone:904-712-3380
Practice Address - Fax:904-712-6210
Is Sole Proprietor?:No
Enumeration Date:2021-12-22
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11019158363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty