Healthcare Provider Details

I. General information

NPI: 1063710564
Provider Name (Legal Business Name): MICHELLE LEE HAGEN ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2011
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

1710 HARRISON ST
BATESVILLE AR
72501-7303
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-8610
  • Fax: 352-273-8612
Mailing address:
  • Phone: 870-262-1200
  • Fax: 870-262-6199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11001744
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberA03503 ANP
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11001744
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: