Provider Demographics
NPI:1205174562
Name:HOGAN, SHARON LORAINE (LMT)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:LORAINE
Last Name:HOGAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:LORAINE
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4444 WHITE RD
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-1345
Mailing Address - Country:US
Mailing Address - Phone:850-356-1661
Mailing Address - Fax:
Practice Address - Street 1:4444 WHITE RD
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-1345
Practice Address - Country:US
Practice Address - Phone:850-356-1661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA71676225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist