Basic Information
| Provider Information | |||||||||
| NPI: | 1003311739 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOGAN | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | KENNEDY | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 599 TAMIAMI TRL N | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341025623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2397321133 | ||||||||
| FaxNumber: | 2397321145 | ||||||||
| Practice Location | |||||||||
| Address1: | 599 TAMIAMI TRL N | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341025623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2397321133 | ||||||||
| FaxNumber: | 2397321145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2018 | ||||||||
| LastUpdateDate: | 03/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | PN411991 | FL | Y | Nursing Service Providers | Licensed Practical Nurse |
ID Information
| ID | Type | State | Issuer | Description | PN411991 | 01 | FL | STATE LISCENSE | OTHER |