Healthcare Provider Details

I. General information

NPI: 1538753843
Provider Name (Legal Business Name): JASON L HAGAN MSN APRN AGACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 E FLETCHER AVE
TAMPA FL
33613-4613
US

IV. Provider business mailing address

3100 E FLETCHER AVE
TAMPA FL
33613-4613
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-7283
  • Fax: 407-303-0473
Mailing address:
  • Phone: 407-303-7283
  • Fax: 407-303-0473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN1101862
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberAPRN1101862
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11011862
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: