Provider Demographics
NPI:1902834179
Name:HAGAN, TERI ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:TERI
Middle Name:ANN
Last Name:HAGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TERI
Other - Middle Name:ANN
Other - Last Name:HAGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:13163 66TH STREET NORTH
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773
Mailing Address - Country:US
Mailing Address - Phone:727-228-7000
Mailing Address - Fax:727-223-3614
Practice Address - Street 1:13163 66TH STREET NORTH
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773
Practice Address - Country:US
Practice Address - Phone:727-228-7000
Practice Address - Fax:727-223-3614
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78785208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118777600Medicaid
FLP00379115OtherRAILROAD MEDICARE
FL020116000Medicaid