Healthcare Provider Details

I. General information

NPI: 1992181051
Provider Name (Legal Business Name): ALISSA GAYLE HOGUE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2015
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13933 17TH ST STE 101
DADE CITY FL
33525-4604
US

IV. Provider business mailing address

13933 17TH ST STE 101
DADE CITY FL
33525-4604
US

V. Phone/Fax

Practice location:
  • Phone: 352-567-6763
  • Fax: 352-567-2146
Mailing address:
  • Phone: 352-567-6763
  • Fax: 352-567-2146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA004496
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberAPRN11019122
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11019122
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: