Provider Demographics
NPI:1912119116
Name:HAGLER, JENNIFER BROOKE I
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:BROOKE
Last Name:HAGLER
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:681 SW CHAPEL HILL ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-6545
Mailing Address - Country:US
Mailing Address - Phone:386-961-8505
Mailing Address - Fax:
Practice Address - Street 1:2086 SW MAIN BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-0005
Practice Address - Country:US
Practice Address - Phone:386-754-2821
Practice Address - Fax:386-754-2822
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA38766225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist