MEDICARE: MRS. HOLLI HACKNEY METCALF NP-C

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	363L00000X	Nurse Practitioner	ARNP9330753	FL

General Provider Information

NPI Number	:	1962940882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HOLLI HACKNEY METCALF NP-C

Provider Business Mailing Address
First Line	:	4528 S GAINES RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-2120
Country	:	US
Telephone Number	:	941-704-2133
Fax Number	:

Provider Business Practice Location Address
First Line	:	4528 S GAINES RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-2120
Country	:	US
Telephone Number	:	941-704-2133
Fax Number	:

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

Provider Enumeration Date	:	02/11/2017
Last Update Date	:	02/11/2017

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