Provider Demographics
NPI:1467466417
Name:HAGENBUCH, JACQUELINE (APRN-C)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:HAGENBUCH
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:HAGENBUCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN-C
Mailing Address - Street 1:113 SEABOARD LN STE 200B
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-8282
Mailing Address - Country:US
Mailing Address - Phone:800-793-7050
Mailing Address - Fax:
Practice Address - Street 1:4800 DEERWOOD CAMPUS PKWY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-8317
Practice Address - Country:US
Practice Address - Phone:800-793-7050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3290112363L00000X
FLAPRN3290112363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P99876Medicare UPIN