Provider Demographics
NPI:1376363960
Name:HAGAN, ABIGAIL (MT-BC)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:HAGAN
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 11TH AVE N APT 4
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-1661
Mailing Address - Country:US
Mailing Address - Phone:941-993-6373
Mailing Address - Fax:
Practice Address - Street 1:520 11TH AVE N APT 4
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-1661
Practice Address - Country:US
Practice Address - Phone:941-993-6373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15834225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist