Provider Demographics
NPI:1255747143
Name:HAGAN, SHANNON (FNP-BC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:HAGAN
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 1:348 BROWNS HILL CT
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-9511
Mailing Address - Country:US
Mailing Address - Phone:804-272-2702
Mailing Address - Fax:804-272-9355
Practice Address - Street 1:348 BROWNS HILL CT
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-9511
Practice Address - Country:US
Practice Address - Phone:804-272-2702
Practice Address - Fax:042-729-3558
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171768363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily