Provider Demographics
NPI:1134164742
Name:HAWKE, JESS (DO)
Entity type:Individual
Prefix:
First Name:JESS
Middle Name:
Last Name:HAWKE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2512 TAMIAMI TRL N
Mailing Address - Street 2:
Mailing Address - City:NOKOMIS
Mailing Address - State:FL
Mailing Address - Zip Code:34275-3476
Mailing Address - Country:US
Mailing Address - Phone:941-966-2342
Mailing Address - Fax:941-966-5864
Practice Address - Street 1:2512 TAMIAMI TRL N
Practice Address - Street 2:
Practice Address - City:NOKOMIS
Practice Address - State:FL
Practice Address - Zip Code:34275-3476
Practice Address - Country:US
Practice Address - Phone:941-966-2342
Practice Address - Fax:941-966-5864
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS09654207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine