Healthcare Provider Details

I. General information

NPI: 1336818517
Provider Name (Legal Business Name): KARSON NICOLE HOAGLAND PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2021
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4771 S CLEVELAND AVE
FORT MYERS FL
33907-1317
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-9800
  • Fax: 239-343-9848
Mailing address:
  • Phone: 239-424-1500
  • Fax: 239-424-1423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPAT9114886
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9114886
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: