Basic Information
| Provider Information | |||||||||
| NPI: | 1659428720 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAGGS | ||||||||
| FirstName: | FLORENCE | ||||||||
| MiddleName: | O | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 73 COASTAL MANOR DR | ||||||||
| Address2: | |||||||||
| City: | LUDOWICI | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123699313 | ||||||||
| FaxNumber: | 9125450043 | ||||||||
| Practice Location | |||||||||
| Address1: | 73 COASTAL MANOR DR | ||||||||
| Address2: | |||||||||
| City: | LUDOWICI | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123699313 | ||||||||
| FaxNumber: | 9125450043 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2007 | ||||||||
| LastUpdateDate: | 05/23/2019 | ||||||||
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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 | 363LW0102X | RN089010 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | 000779017H | 05 | GA | MEDICAID | 000779017I | 05 | GA | MEDICAID |