Healthcare Provider Details

I. General information

NPI: 1265460679
Provider Name (Legal Business Name): NATHAN R HAWKINS PA.C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702A W DRAKE RD
FORT COLLINS CO
80526-5521
US

IV. Provider business mailing address

2500E PROSPECT RD
FORT COLLINS CO
80525-9718
US

V. Phone/Fax

Practice location:
  • Phone: 970-810-0255
  • Fax: 970-966-2599
Mailing address:
  • Phone: 970-493-0112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number3690
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: