Healthcare Provider Details

I. General information

NPI: 1215576624
Provider Name (Legal Business Name): ELIZABETH RAQUEL HAWKINS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 HARRY HINES BLVD
DALLAS TX
75390-4306
US

IV. Provider business mailing address

PO BOX 845347
DALLAS TX
75284-5347
US

V. Phone/Fax

Practice location:
  • Phone: 214-645-8300
  • Fax:
Mailing address:
  • Phone: 469-291-3369
  • Fax: 469-645-0078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP143481
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: