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 1:1019 FLORA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-7025
Mailing Address - Country:US
Mailing Address - Phone:727-698-3963
Mailing Address - Fax:727-698-3963
Practice Address - Street 1:1019 FLORA VISTA ST
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-7025
Practice Address - Country:US
Practice Address - Phone:727-698-3963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-14
Last Update Date:2025-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN2794242363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care