Provider Demographics
NPI:1881166536
Name:O'HAGAN, ELIZABETH J (ARNP, FNP-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:O'HAGAN
Suffix:
Gender:F
Credentials:ARNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 WYLAM DR
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33954-2352
Mailing Address - Country:US
Mailing Address - Phone:941-539-9973
Mailing Address - Fax:
Practice Address - Street 1:103 COUNTY HIGHWAY 138
Practice Address - Street 2:
Practice Address - City:BROADALBIN
Practice Address - State:NY
Practice Address - Zip Code:12025-6902
Practice Address - Country:US
Practice Address - Phone:518-883-1023
Practice Address - Fax:518-883-1293
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF346251363L00000X
FL11000686363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner