Provider Demographics
NPI:1104589571
Name:HOGAN, SHELBY LYNN (FNP)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:LYNN
Last Name:HOGAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:HOLMES
Other - Last Name:HOGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:16892 OLE GRIST RUN
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:DE
Mailing Address - Zip Code:19968-3401
Mailing Address - Country:US
Mailing Address - Phone:770-530-6409
Mailing Address - Fax:
Practice Address - Street 1:16392 COASTAL HWY
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-3611
Practice Address - Country:US
Practice Address - Phone:302-703-9743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0011790363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily