Provider Demographics
NPI:1013097179
Name:HOTKA, SARINA
Entity Type:Individual
Prefix:
First Name:SARINA
Middle Name:
Last Name:HOTKA
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 1:2142 SKYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-5124
Mailing Address - Country:US
Mailing Address - Phone:910-584-2055
Mailing Address - Fax:910-717-9573
Practice Address - Street 1:2018 FORT BRAGG RD
Practice Address - Street 2:SUITE 124
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-7037
Practice Address - Country:US
Practice Address - Phone:910-483-1474
Practice Address - Fax:910-483-2180
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3408251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601509Medicaid