Provider Demographics
NPI:1245454586
Name:HAWTHORNE FAMILY PRACTICE LLC
Entity type:Organization
Organization Name:HAWTHORNE FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ONA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:COLASANTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-481-2400
Mailing Address - Street 1:21815 SE 71ST AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:FL
Mailing Address - Zip Code:32640-3974
Mailing Address - Country:US
Mailing Address - Phone:352-481-2400
Mailing Address - Fax:352-481-2777
Practice Address - Street 1:21815 SE 71ST AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:FL
Practice Address - Zip Code:32640-3974
Practice Address - Country:US
Practice Address - Phone:352-481-2400
Practice Address - Fax:352-481-2777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0063062305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization