Individual
DR. LEE THOMAS HAGENBAUMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3625 UNIVERSITY BLVD S, JACKSONVILLE, FL 32216-4207
(904) 702-6111
Mailing address
9479 HECKSCHER DR, JACKSONVILLE, FL 32226-2420
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
11010755
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/27/2020
Last updated
06/05/2023
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