Provider Demographics
NPI:1659507986
Name:HAWTHORNE, SERDA C (MD)
Entity Type:Individual
Prefix:
First Name:SERDA
Middle Name:C
Last Name:HAWTHORNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SERDA
Other - Middle Name:CAROLIN
Other - Last Name:GURSES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9527 LARAMIE DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-7876
Mailing Address - Country:US
Mailing Address - Phone:850-857-4040
Mailing Address - Fax:
Practice Address - Street 1:1190 E NINE MILE RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-1651
Practice Address - Country:US
Practice Address - Phone:850-857-4040
Practice Address - Fax:850-479-9180
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105621207Q00000X
FLME116450207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine