Healthcare Provider Details

I. General information

NPI: 1134505340
Provider Name (Legal Business Name): JESSICA HAWKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA SCARDINO

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 E BRANDON BLVD # 45757
BRANDON FL
33511-5509
US

IV. Provider business mailing address

1032 E BRANDON BLVD # 4757
BRANDON FL
33511-5509
US

V. Phone/Fax

Practice location:
  • Phone: 866-277-8884
  • Fax: 407-789-3156
Mailing address:
  • Phone: 866-277-8884
  • Fax: 407-789-3156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-15-19280
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: