Provider Demographics
NPI:1366095564
Name:HATWIG, DANA M (APRN)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:M
Last Name:HATWIG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 STATE ROAD 13 STE 106-493
Mailing Address - Street 2:
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-3860
Mailing Address - Country:US
Mailing Address - Phone:904-517-8900
Mailing Address - Fax:
Practice Address - Street 1:450 STATE ROAD 13 STE 106-493
Practice Address - Street 2:
Practice Address - City:ST JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-3860
Practice Address - Country:US
Practice Address - Phone:904-517-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11003309363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health