MEDICARE: DANA M HATWIG APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11003309	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366095564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA M HATWIG APRN

Provider Business Mailing Address
First Line	:	450 STATE ROAD 13 N STE 106-493
Second Line	:
City	:	ST JOHNS
State	:	FL
Zip	:	32259-3860
Country	:	US
Telephone Number	:	904-517-8900
Fax Number	:	949-703-8088

Provider Business Practice Location Address
First Line	:	450 STATE ROAD 13 STE 106-493
Second Line	:
City	:	ST JOHNS
State	:	FL
Zip	:	32259-3860
Country	:	US
Telephone Number	:	904-517-8900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2019
Last Update Date	:	01/21/2026

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