Healthcare Provider Details

I. General information

NPI: 1164228581
Provider Name (Legal Business Name): SIERRA M HOGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 SW 34TH AVE
OCALA FL
34474-7456
US

IV. Provider business mailing address

PO BOX 116
GULF HAMMOCK FL
32639-0100
US

V. Phone/Fax

Practice location:
  • Phone: 352-445-1200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11037914
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: