Ketchum, Alicia Hagenau

Ketchum, Alicia Hagenau is an individual health care provider with primary practice located at 120 Medical Blvd Ste 102, Spring Hill FL 34609-0220. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Ketchum, Alicia Hagenau can be contacted via phone (352) 686-0086.

Contact Information

Primary practice address
120 Medical Blvd Ste 102 Spring Hill FL 34609-0220
Phone: (352) 686-0086
Fax: (352) 684-2081
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X ARNP9278289 Florida

Profile Details

NPI number 1588080501
LBN Legal business name Ketchum, Alicia Hagenau
Credentials ARNP-C
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 14th, 2014
Last updated Feb 20th, 2017 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1588080501 NPPES
Florida MEDICAID 016886300

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