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General NPI Number Information
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NPI Number | 1588080501
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Entity Type | Individual
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Provider Name | ALICIA HAGENAU KETCHUM ARNP-C
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Gender | Female
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Dates
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Enumeration Date | 03/14/2014
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Last Update Date | 02/20/2017
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Provider Practice Location Address
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Address Line | 120 MEDICAL BLVD STE 102
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City | SPRING HILL
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State | FL
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Zip | 34609-0220
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Country | US
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Telephone | 352-686-0086
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Fax | 352-684-2081
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Provider Business Mailing Address
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Address Line | 14690 SPRING HILL DR STE 100 ATTN:CREDENTIALING
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City | SPRING HILL
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State | FL
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Zip | 34609-8102
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Country | US
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Telephone | 352-799-0046
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Fax | 352-606-2857
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP9278289
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License Number State | FL
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