Healthcare Provider Details

I. General information

NPI: 1477925345
Provider Name (Legal Business Name): NICOLE DANIELLE HAWKINS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2015
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 GREENSPRING AVE
BALTIMORE MD
21211-1310
US

IV. Provider business mailing address

343 CHIMNEY OAK DR
JOPPA MD
21085-4729
US

V. Phone/Fax

Practice location:
  • Phone: 443-923-4582
  • Fax:
Mailing address:
  • Phone: 443-858-7764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR187100
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR187100
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: