Provider Demographics
NPI:1174586119
Name:HAWLEY, TINA (CRNP)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:HAWLEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 YORK ST
Mailing Address - Street 2:
Mailing Address - City:CORRY
Mailing Address - State:PA
Mailing Address - Zip Code:16407-1420
Mailing Address - Country:US
Mailing Address - Phone:814-665-8288
Mailing Address - Fax:814-664-8618
Practice Address - Street 1:300 YORK ST
Practice Address - Street 2:
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407-1420
Practice Address - Country:US
Practice Address - Phone:814-665-8288
Practice Address - Fax:814-664-8618
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP004410B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02563679Medicaid
NY02563679Medicaid
NYRB0387Medicare PIN
PA953058Q24Medicare ID - Type Unspecified