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General NPI Number Information
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NPI Number | 1245454586
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Entity Type | Organization
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Legal Business Name | HAWTHORNE FAMILY PRACTICE LLC
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 07/19/2007
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Provider Practice Location Address
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Address Line | 21815 SE 71ST AVE
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City | HAWTHORNE
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State | FL
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Zip | 32640-3974
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Country | US
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Telephone | 352-481-2400
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Fax | 352-481-2777
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Provider Business Mailing Address
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Address Line | 21815 SE 71ST AVE
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City | HAWTHORNE
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State | FL
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Zip | 32640-3974
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Country | US
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Telephone | 352-481-2400
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Fax | 352-481-2777
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. ONA MARIE COLASANTE
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Credential | MD
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Telephone | 352-481-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | ME0063062
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License Number State | FL
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