Healthcare Provider Details

I. General information

NPI: 1144538992
Provider Name (Legal Business Name): FLORENCE HAGAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8221 WILLOW OAKS CORPORATE DR
FAIRFAX VA
22031-4512
US

IV. Provider business mailing address

1605 DOROTHY LN
WOODBRIDGE VA
22191-3480
US

V. Phone/Fax

Practice location:
  • Phone: 703-383-8500
  • Fax:
Mailing address:
  • Phone: 703-680-0235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number0001196719
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024181870
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: