Provider Demographics
NPI:1053913103
Name:HAWKINS, LATISHA ANN (RN)
Entity type:Individual
Prefix:
First Name:LATISHA
Middle Name:ANN
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6925 LOMA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-6428
Mailing Address - Country:US
Mailing Address - Phone:817-323-3309
Mailing Address - Fax:
Practice Address - Street 1:6925 LOMA VISTA DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-6428
Practice Address - Country:US
Practice Address - Phone:817-323-3309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX957386163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse