Provider Demographics
NPI:1205639770
Name:HAWK, KETURAH KOLETT (RN)
Entity type:Individual
Prefix:
First Name:KETURAH
Middle Name:KOLETT
Last Name:HAWK
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 1:12128 RAMBLING STREAM DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-8011
Mailing Address - Country:US
Mailing Address - Phone:813-445-0989
Mailing Address - Fax:
Practice Address - Street 1:641 49TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-7320
Practice Address - Country:US
Practice Address - Phone:727-826-0958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9541714163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse