Provider Demographics
NPI:1609858000
Name:HAWKINS, JENNIFER NOVAK (PT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:NOVAK
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:MICHELLE
Other - Last Name:NOVAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3809 PLAZA DR
Mailing Address - Street 2:112
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4625
Mailing Address - Country:US
Mailing Address - Phone:760-941-2630
Mailing Address - Fax:760-941-4617
Practice Address - Street 1:3809 PLAZA DR
Practice Address - Street 2:112
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4625
Practice Address - Country:US
Practice Address - Phone:760-941-2630
Practice Address - Fax:760-941-4617
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-19
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39442225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZQ51272Medicare UPIN
AZ105231Medicare ID - Type Unspecified