Provider Demographics
NPI:1962181263
Name:BOGAN, SYREETA (APRN)
Entity type:Individual
Prefix:
First Name:SYREETA
Middle Name:
Last Name:BOGAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 PARSONS PARK DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6066
Mailing Address - Country:US
Mailing Address - Phone:813-684-5255
Mailing Address - Fax:813-654-7457
Practice Address - Street 1:116 PARSONS PARK DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6066
Practice Address - Country:US
Practice Address - Phone:813-684-5255
Practice Address - Fax:813-654-7457
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11023578363LF0000X
FLAPRN11023578363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily