Healthcare Provider Details

I. General information

NPI: 1063543809
Provider Name (Legal Business Name): TANIA MARIA HOGAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 N 3RD ST STE 170 INSPIRIS
PHOENIX AZ
85004-1425
US

IV. Provider business mailing address

20425 N 7TH ST APT 2050
PHOENIX AZ
85024-6010
US

V. Phone/Fax

Practice location:
  • Phone: 602-462-1132
  • Fax:
Mailing address:
  • Phone: 602-462-1132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF304493
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: