Provider Demographics
NPI:1619714540
Name:HOGAN, SHEA ALYSE (FNP-BC)
Entity type:Individual
Prefix:
First Name:SHEA
Middle Name:ALYSE
Last Name:HOGAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3830 W NEPTUNE ST # D1
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-5840
Mailing Address - Country:US
Mailing Address - Phone:813-563-0063
Mailing Address - Fax:
Practice Address - Street 1:3830 W NEPTUNE ST # D1
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-5840
Practice Address - Country:US
Practice Address - Phone:813-563-0063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11033717207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine