Provider Demographics
NPI:1083204473
Name:HAWKINS-JEWETT, CHANDRA MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:CHANDRA
Middle Name:MICHELLE
Last Name:HAWKINS-JEWETT
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CHANDRA
Other - Middle Name:MICHELLE
Other - Last Name:HAWKINS-JEWETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4132 MERRILLVILLE DR APT 16208
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-6260
Mailing Address - Country:US
Mailing Address - Phone:772-708-6877
Mailing Address - Fax:
Practice Address - Street 1:755 27TH AVE SW STE 9&10
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32968-4200
Practice Address - Country:US
Practice Address - Phone:561-616-8411
Practice Address - Fax:561-616-8412
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator