MEDICARE: STEPHANIE HAWK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1074192	TX

General Provider Information

NPI Number	:	1588305544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE HAWK

Provider Business Mailing Address
First Line	:	1303 MCCULLOUGH AVE STE 138
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-5604
Country	:	US
Telephone Number	:	210-455-3309
Fax Number	:

Provider Business Practice Location Address
First Line	:	1303 MCCULLOUGH AVE STE 138
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-5604
Country	:	US
Telephone Number	:	210-455-3309
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2022
Last Update Date	:	04/05/2022

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Directions to “ STEPHANIE HAWK ” Practice Location

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