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NPI Code Detail

MEDICARE: DR. JACQUELINE T. HOLMSTROM

MEDICARE: DR. JACQUELINE T. HOLMSTROM
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
1207R00000XInternal Medicine PhysicianOS12792FL

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 : 1649684093
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACQUELINE T. HOLMSTROM
Provider Business Mailing Address
First Line : PO BOX 198441
Second Line :
City : ATLANTA
State : GA
Zip : 30384-8441
Country : US
Telephone Number : 813-745-7365
Fax Number : 813-449-8618
Provider Business Practice Location Address
First Line : 12902 USF MAGNOLIA DR
Second Line :
City : TAMPA
State : FL
Zip : 33612-9416
Country : US
Telephone Number : 813-745-7365
Fax Number : 813-449-8618
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2014
Last Update Date : 03/16/2026

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