Provider Demographics
NPI:1124894019
Name:HAWKINS, TRACIE (MSN, APN, FNP-C)
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:MSN, APN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 CROWS NEST CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-6109
Mailing Address - Country:US
Mailing Address - Phone:856-816-3830
Mailing Address - Fax:
Practice Address - Street 1:3906 CHURCH RD
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1108
Practice Address - Country:US
Practice Address - Phone:856-266-5260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ14965200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily