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General NPI Number Information
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NPI Number | 1093164063
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Entity Type | Organization
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Legal Business Name | COGNIZANT HEALTH LLC
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Dates
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Enumeration Date | 06/09/2016
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Last Update Date | 06/09/2016
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Provider Practice Location Address
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Address Line | 1415 PANTHER LN
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City | NAPLES
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State | FL
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Zip | 34109-7874
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Country | US
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Telephone | 239-404-3379
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Fax | 239-591-6717
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Provider Business Mailing Address
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Address Line | 250 PARK SHORE DR SUITE 202
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City | NAPLES
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State | FL
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Zip | 34103-2688
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Country | US
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Telephone | 480-313-0223
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Fax | 239-591-6717
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Authorized Official
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Title or Position | SOLE OWNER
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Name | ALAN K HAGSTROM
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Credential | MD
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Telephone | 239-404-3379
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME114651
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License Number State | FL
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