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Provider Information for 1447513718

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

TINA MAREE AGAN APRN, FNP-C

Gender: FEMALE

Individual NPI: 1447513718

Calendar   Last Updated:  2020-01-08
  Certification Date:  2020-01-08

Details

Name Value
NPI 1447513718
Enumeration Date 2012-06-20
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 12470 TELECOM DRIVE, SUITE 300W
TEMPLE TERRACE, FL 33637-0904
United States

Phone: | Fax:
View Map External Link
Primary Practice Address 7501 142ND AVE LOT 530
LARGO, FL 33771-4610
United States

Phone: 727-754-1719 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
MEDICAID FL 009642500
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 363LF0000X - Nurse Practitioner Family FL ARNP9369198