Healthcare Provider Details

I. General information

NPI: 1043614407
Provider Name (Legal Business Name): JESSICA ELIZABETH HOAGLIN AT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2014
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 HARD RD
DUBLIN OH
43016-8349
US

IV. Provider business mailing address

4000 HARD RD
DUBLIN OH
43016-8358
US

V. Phone/Fax

Practice location:
  • Phone: 614-718-8332
  • Fax: 614-718-8348
Mailing address:
  • Phone: 614-718-8332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number003652
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: