Provider Demographics
NPI:1154942431
Name:HAWKINS, CARLA
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GARDEN OF EDEN HOME
Other - Middle Name:
Other - Last Name:CARE LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1132 FOX FRST
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-2335
Mailing Address - Country:US
Mailing Address - Phone:901-283-2150
Mailing Address - Fax:
Practice Address - Street 1:1132 FOXFORREST CIR
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-2335
Practice Address - Country:US
Practice Address - Phone:901-283-2150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9526402163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA