Provider Demographics
NPI:1992181051
Name:HOGUE, ALISSA GAYLE (APRN)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:GAYLE
Last Name:HOGUE
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 1:13933 17TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-4604
Mailing Address - Country:US
Mailing Address - Phone:352-567-6763
Mailing Address - Fax:352-567-2146
Practice Address - Street 1:13933 17TH ST STE 101
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-4604
Practice Address - Country:US
Practice Address - Phone:352-567-6763
Practice Address - Fax:352-567-2146
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004496363LF0000X
FLAPRN110191222083P0011X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine