Provider Demographics
NPI:1821013491
Name:HODGENS, TANYA J (FNP)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:J
Last Name:HODGENS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15415 PANAMA CITY BEACH PKWY
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32413-5409
Mailing Address - Country:US
Mailing Address - Phone:850-588-3589
Mailing Address - Fax:850-588-3593
Practice Address - Street 1:15415 PANAMA CITY BEACH PKWY
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32413-5409
Practice Address - Country:US
Practice Address - Phone:850-588-3589
Practice Address - Fax:250-588-3593
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-132780363LF0000X
FL11012958363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010175305Medicaid
VA007976J66Medicare ID - Type Unspecified
VA010175305Medicaid