Provider Demographics
NPI:1568953669
Name:BAGLEY, CHRISTOPHER DWAYNE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DWAYNE
Last Name:BAGLEY
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10267 SW 46TH CT
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-4067
Mailing Address - Country:US
Mailing Address - Phone:352-208-3854
Mailing Address - Fax:
Practice Address - Street 1:10267 SW 46TH CT
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-4067
Practice Address - Country:US
Practice Address - Phone:352-208-3854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9374264163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse