Provider Demographics
NPI:1649430224
Name:HOGGARD, ADREANNE MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:ADREANNE
Middle Name:MARIE
Last Name:HOGGARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ADREANNE
Other - Middle Name:MARIE
Other - Last Name:ETHRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2400 N COURTENAY PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4127
Mailing Address - Country:US
Mailing Address - Phone:321-985-9097
Mailing Address - Fax:321-301-4869
Practice Address - Street 1:2400 N COURTENAY PKWY STE 100
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953
Practice Address - Country:US
Practice Address - Phone:321-985-9097
Practice Address - Fax:321-301-4869
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK28691207Q00000X
FLME136671207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200388640AMedicaid
OK200388640AMedicaid
OKOKAAA1901Medicare PIN
OKOKAAA3487Medicare PIN