Provider Demographics
NPI:1346525276
Name:HAWKINS, MOLLY COLLEEN (CSA)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:COLLEEN
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 15664
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23328-5664
Mailing Address - Country:US
Mailing Address - Phone:813-854-1664
Mailing Address - Fax:813-854-2244
Practice Address - Street 1:624 WICKWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322
Practice Address - Country:US
Practice Address - Phone:813-854-1664
Practice Address - Fax:813-854-2244
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA3714363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical