Provider Demographics
NPI:1790711133
Name:HAWKINS, VICENTA MARIBEL (DO)
Entity Type:Individual
Prefix:DR
First Name:VICENTA
Middle Name:MARIBEL
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:MARIBEL
Other - Middle Name:VICENTA
Other - Last Name:PALACIOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1530 CORNERSTONE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32117
Mailing Address - Country:US
Mailing Address - Phone:386-274-7800
Mailing Address - Fax:386-274-7801
Practice Address - Street 1:701 6TH ST S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4814
Practice Address - Country:US
Practice Address - Phone:727-823-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9189207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272885100Medicaid
FL29520OtherBLUE CROSS OF FLORIDA
FL212699OtherAMERIGROUP
FLU5496ZMedicare PIN
FL212699OtherAMERIGROUP
FL29520OtherBLUE CROSS OF FLORIDA