Provider Demographics
NPI:1740464676
Name:HAGMANN, PATRICIA ANN (LPN)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:HAGMANN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:MCCORMACK LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1705 COLONIAL BLVD
Mailing Address - Street 2:PEDIATRIC SERVICES OF AMERICA
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1705 COLONIAL BLVD
Practice Address - Street 2:PEDIATRIC SERVICES OF AMERICA
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908
Practice Address - Country:US
Practice Address - Phone:239-939-3159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1666641164W00000X
FLPN5150091164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse