Provider Demographics
NPI:1912880204
Name:HAWTHORNE, SPENCER DEON JR
Entity type:Individual
Prefix:MR
First Name:SPENCER
Middle Name:DEON
Last Name:HAWTHORNE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 HICKORY GLEN DR
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-4762
Mailing Address - Country:US
Mailing Address - Phone:407-747-9655
Mailing Address - Fax:
Practice Address - Street 1:820 HICKORY GLEN DR
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-4762
Practice Address - Country:US
Practice Address - Phone:407-747-9655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-26
Last Update Date:2025-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver