MEDICARE: BRITTANY NICOLE HOGAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	152W00000X	Optometrist	OPC6321	FL

General Provider Information

NPI Number	:	1275233892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANY NICOLE HOGAN

Provider Business Mailing Address
First Line	:	PO BOX 207151
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75320-7151
Country	:	US
Telephone Number	:	636-200-4393
Fax Number	:	636-527-0766

Provider Business Practice Location Address
First Line	:	12591 SORRENTO RD STE B
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32507-8754
Country	:	US
Telephone Number	:	850-497-0711
Fax Number	:	850-497-0733

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2023
Last Update Date	:	07/31/2023

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Directions to “ BRITTANY NICOLE HOGAN ” Practice Location

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