Provider Demographics
NPI:1194123729
Name:FOGG, MARK (DCNP, FNP, APRN)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:FOGG
Suffix:
Gender:M
Credentials:DCNP, FNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10820 SHELDON RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-5117
Mailing Address - Country:US
Mailing Address - Phone:813-880-7546
Mailing Address - Fax:813-249-5210
Practice Address - Street 1:10820 SHELDON RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-5117
Practice Address - Country:US
Practice Address - Phone:813-880-7546
Practice Address - Fax:813-249-5210
Is Sole Proprietor?:No
Enumeration Date:2014-12-14
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN2794242363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner