Healthcare Provider Details

I. General information

NPI: 1447666086
Provider Name (Legal Business Name): KEVIN PATRICK HANAWAY DNP, MBA, APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3126 N FEDERAL HWY
LIGHTHOUSE POINT FL
33064-6738
US

IV. Provider business mailing address

15280 NW 79TH CT STE 200
MIAMI LAKES FL
33016-5873
US

V. Phone/Fax

Practice location:
  • Phone: 954-785-0900
  • Fax: 954-786-3497
Mailing address:
  • Phone: 305-558-3724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN3361362
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN3361362
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: