Provider Demographics
NPI:1679106447
Name:HOGAN, ANNIE ROSE (CPNP-PC, MSN)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:ROSE
Last Name:HOGAN
Suffix:
Gender:F
Credentials:CPNP-PC, MSN
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:ROSE
Other - Last Name:HICKOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:238 CENTRE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37146-7081
Mailing Address - Country:US
Mailing Address - Phone:615-746-4040
Mailing Address - Fax:615-746-4044
Practice Address - Street 1:238 CENTRE ST STE 100
Practice Address - Street 2:
Practice Address - City:PLEASANT VIEW
Practice Address - State:TN
Practice Address - Zip Code:37146-7081
Practice Address - Country:US
Practice Address - Phone:615-746-4040
Practice Address - Fax:615-746-4044
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000027128363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics