MEDICARE: RONNIE D HOLLOMAN

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
1	253Z00000X	In Home Supportive Care Agency		FL

General Provider Information

NPI Number	:	1710590773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONNIE D HOLLOMAN

Provider Business Mailing Address
First Line	:	6302 OLD WINTER GARDEN RD STE D
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-1374
Country	:	US
Telephone Number	:	407-296-0995
Fax Number	:

Provider Business Practice Location Address
First Line	:	6302 OLD WINTER GARDEN RD STE D
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-1374
Country	:	US
Telephone Number	:	404-766-6122
Fax Number	:	407-704-4953

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2020
Last Update Date	:	08/28/2020

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Directions to “ RONNIE D HOLLOMAN ” Practice Location

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