Provider Demographics
NPI:1760588743
Name:HAGINS, LINDA BANKS (FNP-C)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:BANKS
Last Name:HAGINS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 ELMO ST
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3711
Mailing Address - Country:US
Mailing Address - Phone:229-924-5200
Mailing Address - Fax:229-924-0073
Practice Address - Street 1:906 ELMO ST
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3711
Practice Address - Country:US
Practice Address - Phone:229-924-5200
Practice Address - Fax:229-924-0073
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA RN118093363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA285996480DMedicaid