Provider Demographics
NPI:1083489983
Name:HAWKINS, VANESSA ANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:ANN
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4614 WAYNE RD
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-2732
Mailing Address - Country:US
Mailing Address - Phone:626-437-1392
Mailing Address - Fax:
Practice Address - Street 1:330 OLD NEWPORT BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4121
Practice Address - Country:US
Practice Address - Phone:949-646-6441
Practice Address - Fax:949-646-5719
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF95025842363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily