Healthcare Provider Details

I. General information

NPI: 1114896107
Provider Name (Legal Business Name): AMY HOAGLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2025
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6317 BARBARA ST
JUPITER FL
33458-6678
US

IV. Provider business mailing address

6317 BARBARA ST
JUPITER FL
33458-6678
US

V. Phone/Fax

Practice location:
  • Phone: 561-427-5508
  • Fax:
Mailing address:
  • Phone: 561-427-5508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1237732
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: