Provider Demographics
NPI:1164773610
Name:HATWELL, CHRISTOPHER MARTIN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:MARTIN
Last Name:HATWELL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:531 BALD EAGLE DR
Mailing Address - Street 2:MARCO ISLAND MEDICAL CENTER
Mailing Address - City:MARCO ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34145-2700
Mailing Address - Country:US
Mailing Address - Phone:239-393-2000
Mailing Address - Fax:239-393-0355
Practice Address - Street 1:531 BALD EAGLE DR
Practice Address - Street 2:MARCO ISLAND MEDICAL CENTER
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145-2700
Practice Address - Country:US
Practice Address - Phone:239-393-2000
Practice Address - Fax:239-393-0355
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9106750363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007241200Medicaid
FLY0E6EOtherBCBS OF FL