Healthcare Provider Details

I. General information

NPI: 1104612704
Provider Name (Legal Business Name): NADIA HOGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2025
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 61ST ST W
BRADENTON FL
34209-5528
US

IV. Provider business mailing address

4411 BEE RIDGE RD # 309
SARASOTA FL
34233-2514
US

V. Phone/Fax

Practice location:
  • Phone: 941-667-9070
  • Fax: 941-296-8501
Mailing address:
  • Phone: 941-926-6553
  • Fax: 941-296-8501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11038872
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: