Provider Demographics
NPI:1427619329
Name:HAWKINS, SALLY ANN (ARNP FNP-BC)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:ANN
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:ARNP FNP-BC
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:HAWKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:705 DOLLY BEN CT
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-5735
Mailing Address - Country:US
Mailing Address - Phone:863-258-2870
Mailing Address - Fax:
Practice Address - Street 1:705 DOLLY BEN CT
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-5735
Practice Address - Country:US
Practice Address - Phone:863-258-2870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-22
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11002868207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine