Provider Demographics
NPI:1558312587
Name:HAWK, LINDA E (NP)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:E
Last Name:HAWK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13939 E 14TH ST STE 180
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2601
Mailing Address - Country:US
Mailing Address - Phone:510-263-3300
Mailing Address - Fax:510-263-3350
Practice Address - Street 1:13939 E 14TH ST STE 180
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2601
Practice Address - Country:US
Practice Address - Phone:510-263-3300
Practice Address - Fax:510-263-3350
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA227157363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ1810ZMedicaid
CAZZZ1810ZMedicare ID - Type Unspecified