Provider Demographics
NPI:1013533579
Name:HAWKINS, AMANDA LORIN TAYLOR (DNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LORIN TAYLOR
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:RED BUD
Mailing Address - State:IL
Mailing Address - Zip Code:62278-1105
Mailing Address - Country:US
Mailing Address - Phone:618-282-7373
Mailing Address - Fax:618-282-5476
Practice Address - Street 1:325 SPRING ST
Practice Address - Street 2:
Practice Address - City:RED BUD
Practice Address - State:IL
Practice Address - Zip Code:62278-1105
Practice Address - Country:US
Practice Address - Phone:618-282-7373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209023593363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily