Provider Demographics
NPI:1497512230
Name:HAWTHORNE RIOS, ANITA
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:HAWTHORNE RIOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5745 CANTON CV STE 121
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-5012
Mailing Address - Country:US
Mailing Address - Phone:407-647-2550
Mailing Address - Fax:949-863-6477
Practice Address - Street 1:5745 CANTON CV STE 121
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-5012
Practice Address - Country:US
Practice Address - Phone:407-647-2550
Practice Address - Fax:949-863-6477
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11031484363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty