MEDICARE: SAGEN THOMAS DANIELS CRNP

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	363LF0000X	Family Nurse Practitioner	1-182814	AL

General Provider Information

NPI Number	:	1689517914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAGEN THOMAS DANIELS CRNP

Provider Business Mailing Address
First Line	:	355 COUNTY ROAD 123
Second Line	:
City	:	DUTTON
State	:	AL
Zip	:	35744-7525
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 SIVLEY RD SW
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-4421
Country	:	US
Telephone Number	:	256-265-1000
Fax Number	:

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

Provider Enumeration Date	:	04/11/2026
Last Update Date	:	04/11/2026

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