Healthcare Provider Details

I. General information

NPI: 1255747143
Provider Name (Legal Business Name): SHANNON HAGAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2014
Last Update Date: 08/29/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 BROWNS HILL CT
MIDLOTHIAN VA
23114-9511
US

IV. Provider business mailing address

348 BROWNS HILL CT
MIDLOTHIAN VA
23114-9511
US

V. Phone/Fax

Practice location:
  • Phone: 804-272-2702
  • Fax: 42-729-3558
Mailing address:
  • Phone: 804-272-2702
  • Fax: 804-272-9355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024171768
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: