Provider Demographics
NPI:1568101780
Name:HAGEN, NATALIE GENE (APRN)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:GENE
Last Name:HAGEN
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 1:943 S BENEVA RD STE 106
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-2471
Mailing Address - Country:US
Mailing Address - Phone:941-955-6748
Mailing Address - Fax:941-953-6023
Practice Address - Street 1:943 S BENEVA RD STE 106
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-2471
Practice Address - Country:US
Practice Address - Phone:941-955-6748
Practice Address - Fax:941-953-6023
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-04
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11020008363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health