Provider Demographics
NPI:1093849564
Name:HAWBAKER, TIMOTHY PARKER (NP, LAC)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:PARKER
Last Name:HAWBAKER
Suffix:
Gender:M
Credentials:NP, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CEDAREDGE
Mailing Address - State:CO
Mailing Address - Zip Code:81413-3331
Mailing Address - Country:US
Mailing Address - Phone:970-856-4729
Mailing Address - Fax:
Practice Address - Street 1:175 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CEDAREDGE
Practice Address - State:CO
Practice Address - Zip Code:81413-3331
Practice Address - Country:US
Practice Address - Phone:970-856-4729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO928171100000X
COAPN.0992671-NP363LP2300X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No171100000XOther Service ProvidersAcupuncturist