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NPI Code Detail

MEDICARE: HOLLY WISEMAN

MEDICARE: HOLLY WISEMAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184308926
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOLLY WISEMAN
Provider Business Mailing Address
First Line : 3109 W DR MARTIN LUTHER KING JR BLVD STE 500
Second Line :
City : TAMPA
State : FL
Zip : 33607-6220
Country : US
Telephone Number : 813-289-0760
Fax Number :
Provider Business Practice Location Address
First Line : 3109 W DR MARTIN LUTHER KING JR BLVD STE 500
Second Line :
City : TAMPA
State : FL
Zip : 33607-6220
Country : US
Telephone Number : 813-289-0760
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2023
Last Update Date : 07/24/2025

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Directions to “ HOLLY WISEMAN ” Practice Location

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