Healthcare Provider Details

I. General information

NPI: 1770564452
Provider Name (Legal Business Name): KAREN HAGEROTT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5153 N 9TH AVE SUITE 304
PENSACOLA FL
32504-8785
US

IV. Provider business mailing address

5153 N 9TH AVE SUITE 304
PENSACOLA FL
32504-8785
US

V. Phone/Fax

Practice location:
  • Phone: 850-484-7800
  • Fax: 850-484-7811
Mailing address:
  • Phone: 850-484-7800
  • Fax: 850-484-7811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY4571
License Number StateFL

VIII. Authorized Official

Name: DR. KAREN HAGEROTT
Title or Position: NEUROPSYCHOLOGIST
Credential: PHD
Phone: 850-484-7800