Provider Demographics
NPI:1033508635
Name:HAWK, SHUNTELLE (FNP-C)
Entity Type:Individual
Prefix:
First Name:SHUNTELLE
Middle Name:
Last Name:HAWK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:SHUNTELLE
Other - Middle Name:
Other - Last Name:WHITESIDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3003 N CENTRAL AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2929
Mailing Address - Country:US
Mailing Address - Phone:602-685-6000
Mailing Address - Fax:
Practice Address - Street 1:1250 S CLEARVIEW AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-3378
Practice Address - Country:US
Practice Address - Phone:480-663-2430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN138878363LP0808X
AZAP7573363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily