Healthcare Provider Details

I. General information

NPI: 1881421238
Provider Name (Legal Business Name): LATERRENCE HAWKINS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32431 SPRING CORRAL CT
WESLEY CHAPEL FL
33545-1651
US

IV. Provider business mailing address

32431 SPRING CORRAL CT
WESLEY CHAPEL FL
33545-1651
US

V. Phone/Fax

Practice location:
  • Phone: 321-505-6194
  • Fax:
Mailing address:
  • Phone: 321-505-6194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN9286524
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: