Provider Demographics
NPI:1366611931
Name:HAWKS, LESLEY A (CRNA)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:A
Last Name:HAWKS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 PARK ESTATES SQ
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-4181
Mailing Address - Country:US
Mailing Address - Phone:941-497-1949
Mailing Address - Fax:
Practice Address - Street 1:5342 CLARK ROAD
Practice Address - Street 2:SUITE 130
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-5000
Practice Address - Country:US
Practice Address - Phone:941-504-8480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37623367500000X
FLAPRN2835962367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered